title: Fluid overload is associated with impaired oxygenation and morbidity in critically ill children.
abstract: BACKGROUND
  Fluid overload is common in the critically ill and is thought to contribute to oxygenation failure and mortality. Since increasing disease severity often requires more fluid for resuscitation, it is unclear whether fluid overload is a causative factor in morbidity or is simply an indicator of disease severity.
  
  
  OBJECTIVE
  Investigate the association between fluid overload and oxygenation while controlling for severity of illness by daily Pediatric Logistic Organ Dysfunction scores.
  
  
  METHODS
  Retrospective chart review, tertiary children's hospital.
  
  
  METHODS
  The oxygenation index, fluid overload percent, and daily Pediatric Logistic Organ Dysfunction scores were obtained in a retrospective chart review of 80 patients (mean age 58.7 ± 73.0 months) with respiratory failure. Univariate and multivariate approaches were used to assess the independent relation between fluid overload percent and duration of stay and ventilation.
  
  
  METHODS
  None.
  
  
  RESULTS
  Higher peak fluid overload percent predicted higher peak oxygenation index, independent of age, gender, and Pediatric Logistic Organ Dysfunction (p = .009). Fluid overload percent ≥15% on any given day was also independently associated with that day's oxygenation index, controlled for age, gender, and Pediatric Logistic Organ Dysfunction (p < .05). Peak fluid overload percent and severe fluid overload percent (≥15%) were both independently associated with longer duration of ventilation (p = .004, p = .01), and pediatric intensive care unit (p = .008, p = .01) and hospital length of stay (p = .02, p = .04), controlled for age, gender, Pediatric Logistic Organ Dysfunction, and in the case of ventilation, respiratory admission.
  
  
  CONCLUSIONS
  This is the first study to report that positive fluid balance adversely affected the pediatric intensive care unit course in children who did not receive renal replacement therapy. While timely administration of fluids is lifesaving, positive fluid balance after hemodynamic stabilization may impact organ function and negatively influence important outcomes in critically ill patients.
authors.affiliation: Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. aysea@bcm.edu
authors.forename: Ayse A
authors.initials: AA
authors.lastname: Arikan
authors.forename: Michael
authors.initials: M
authors.lastname: Zappitelli
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
authors.forename: Amrita
authors.initials: A
authors.lastname: Naipaul
authors.forename: Larry S
authors.initials: LS
authors.lastname: Jefferson
authors.forename: Laura L
authors.initials: LL
authors.lastname: Loftis
mesh_terms: D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data; D016638:Critical Illness; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D016016:Proportional Hazards Models; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance / Q000097:blood / Q000209:etiology* / Q000628:therapy
chemical_list: D010100:Oxygen