Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis.
OBJECTIVE
Continuous venovenous hemofiltration (CVVH) is used for renal replacement and fluid management in critically ill children. A previous small study suggested that survival was associated with less percent fluid overload (%FO) in the intensive care unit (ICU) before hemofiltration. We reviewed our experience with a large series of pediatric CVVH patients to evaluate factors associated with outcome.


METHODS
Retrospective chart review.


METHODS
Tertiary children's hospital.


METHODS
CVVH pediatric ICU patients from November 1997 to January 2003.


METHODS
None.


RESULTS
%FO was defined as total fluid input minus output (up to 7 days before CVVH for both hospital stay and ICU stay) divided by body weight. One hundred thirteen patients received CVVH; 69 survived (61%). Multiple organ dysfunction syndrome (MODS) was present in 103 patients; 59 survived (57%). Median patient age was 9.6 yrs (25th, 75th percentile: 2.5, 14.3). Median %FO was significantly lower in survivors vs. nonsurvivors for all patients (7.8% [2.0, 16.7] vs. 15.1% [4.9, 25.9]; p =.02] and in patients with > or =3-organ MODS (9.2% [5.1,16.7] vs. 15.5% [8.3, 28.6]; p =.01). The Pediatric Risk of Mortality Score III at CVVH initiation also was associated with survival in these groups, but by multivariate analysis, %FO was independently associated with survival in patients with > or =3-organ MODS (p =.01).


CONCLUSIONS
Survival in critically ill children receiving CVVH in this large series was higher than in previous reports. CVVH survival may be associated with less %FO in patients with > or =3-organ MODS. Prospective studies are necessary to determine whether earlier use of CVVH to control fluid overload in critically ill children can improve survival.
Divisions of Critical Care and ECMO/Advanced Technologies, Children's Healthcare of Atlanta at Egleston, 1405 Clifton Road NE, Atlanta, GA 30322, USA.
Jason A
JA
Foland
James D
JD
Fortenberry
Barry L
BL
Warshaw
Robert
R
Pettignano
Robert K
RK
Merritt
Micheal L
ML
Heard
Kris
K
Rogers
Chris
C
Reid
April J
AJ
Tanner
Kirk A
KA
Easley
D058186:Acute Kidney Injury / Q000097:blood / Q000401:mortality / Q000628:therapy; D001826:Body Fluids; D002648:Child; D003404:Creatinine / Q000097:blood; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy*; D005845:Georgia / Q000453:epidemiology; D006440:Hemofiltration; D006801:Humans; D016015:Logistic Models; D009102:Multiple Organ Failure / Q000401:mortality / Q000628:therapy; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
D003404:Creatinine