The Influence of Fluid Overload on the Length of Mechanical Ventilation in Pediatric Congenital Heart Surgery
- 560 Downloads
Fluid overload and prolonged mechanical ventilation lead to worse outcomes in critically ill children. However, the association between these variables in children following congenital heart surgery is unknown. The objectives of this study were to describe the association between fluid overload and duration of mechanical ventilation, oxygen requirement and radiologic findings of pulmonary and chest wall edema. This study is a retrospective chart review of patients who underwent congenital heart surgery between June 2010 and December 2013. Univariate and multivariate associations between maximum cumulative fluid balance and length of mechanical ventilation and OI were tested using the Spearman correlation test and multiple linear regression models, respectively. There were 85 eligible patients. Maximum cumulative fluid balance was associated with duration of mechanical ventilation (adjusted analysis beta coefficient = 0.53, CI 0.38–0.66, P < 0.001), length of stay in the pediatric intensive care unit (Spearman’s correlation = 0.45, P < 0.001), and presence of chest wall edema and pleural effusions on chest radiograph (Mann–Whitney test, P = 0.003). Amount of red blood cells transfused and use of nitric oxide were independently associated with increased duration of mechanical ventilation (P = 0.012 and 0.014, respectively). Fluid overload is associated with prolonged duration of mechanical ventilation and PICU length of stay after congenital heart surgery. Fluid overload was also associated with physiological markers of respiratory restriction. A randomized controlled trial of a restrictive versus liberal fluid replacement strategy is necessary in this patient population, but in the meantime, accumulating observational evidence suggests that cautious use of fluid in the postoperative care may be warranted.
KeywordsCongenital heart surgery Fluid overload Mechanical ventilation
This work was funded by a grant from the Children’s Hospital of Eastern Ontario Research Institute.
Conflict of interest
This research involves human participants. The institutional research ethics board approved this project and did not require informed consent due to its observational and retrospective nature.
- 4.Curley MA, Harris SK, Fraser KA, Johnson RA, Arnold JH (2006) State Behavioral Scale: a sedation assessment instrument for infants and young children supported on mechanical ventilation. Pediatr Crit Care Med 7(2):107–114. doi: 10.1097/01.PCC.0000200955.40962.38 PubMedCentralCrossRefPubMedGoogle Scholar
- 8.Foland JA, Fortenberry JD, Warshaw BL, Pettignano R, Merritt RK, Heard ML, Rogers K, Reid C, Tanner AJ, Easley KA (2004) Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis. Crit Care Med 32(8):1771–1776. doi: 10.1097/01.CCM.0000132897.52737.49 CrossRefPubMedGoogle Scholar
- 10.Goldstein SL, Somers MJ, Baum MA, Symons JM, Brophy PD, Blowey D, Bunchman TE, Baker C, Mottes T, McAfee N, Barnett J, Morrison G, Rogers K, Fortenberry JD (2005) Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int 67(2):653–658. doi: 10.1111/j.1523-1755.2005.67121.x CrossRefPubMedGoogle Scholar
- 16.Lombel RM, Kommareddi M, Mottes T, Selewski DT, Han YY, Gipson DS, Collins KL, Heung M (2012) Implications of different fluid overload definitions in pediatric stem cell transplant patients requiring continuous renal replacement therapy. Intensive Care Med 38(4):663–669. doi: 10.1007/s00134-012-2503-6 CrossRefPubMedGoogle Scholar
- 22.Randolph AG, Forbes PW, Gedeit RG, Arnold JH, Wetzel RC, Luckett PM, O’Neil ME, Venkataraman ST, Meert KL, Cheifetz IM, Cox PN, Hanson JH (2005) Cumulative fluid intake minus output is not associated with ventilator weaning duration or extubation outcomes in children*. Pediatr Crit Care Med 6:642–647. doi: 10.1097/01.PCC.0000185484.14423.0D CrossRefPubMedGoogle Scholar
- 23.Schneider J, Khemani R, Grushkin C, Bart R (2010) Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med 38(3):933–939. doi: 10.1097/CCM.0b013e3181cd12e1 CrossRefPubMedGoogle Scholar
- 24.Seguin J, Albright B, Vertullo L, Lai P, Dancea A, Bernier PL, Tchervenkov CI, Calaritis C, Drullinsky D, Gottesman R, Zappitelli M (2014) Extent, risk factors, and outcome of fluid overload after pediatric heart surgery*. Crit Care Med 42(12):2591–2599. doi: 10.1097/CCM.0000000000000517 CrossRefPubMedGoogle Scholar
- 25.Seguin J, Albright B, Vertullo L, Lai P, Dancea A, Bernier P-L, Tchervenkov CI, Calaritis C, Drullinsky D, Gottesman R, Zappitelli M (2014) Extent, risk factors, and outcome of fluid overload after pediatric heart surgery. Crit Care Med 1–9. doi: 10.1097/CCM.0000000000000517
- 28.van Belle G (2008) Sample size. In: Statistical rules of thumb. Wiley Series in Probalility and Statistics, Second edn. Wiley, Hoboken. doi: 10.1002/9780470377963