title: Fluid overload at 48 hours is associated with respiratory morbidity but not mortality in a general PICU: retrospective cohort study.
abstract: OBJECTIVE
  Recent evidence suggests that fluid overload may be deleterious to critically ill children. The purpose of this study was to investigate the association of early fluid overload with respiratory morbidity and mortality in patients admitted to a general PICU.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Single, tertiary referral PICU.
  patients aged 0-16 years invasively ventilated at 48 hours post admission, admitted between April 1, 2009, and March 31, 2013.
  
  
  RESULTS
  Data collected included demographics, diagnosis, Pediatric Index of Mortality 2 score, and fluid overload percent at 48 hours from admission. Fluid overload percent was calculated as (cumulative fluid in - cumulative fluid out (L))/hospital admission weight (kg) × 100%. Outcome measures were oxygenation index at 48 hours from admission, death, and invasive ventilation days in survivors. Data are reported as median (interquartile range) and were analyzed using nonparametric tests. The median age was 1.05 years (0.3-4.2 yr). Fifty-three patients (8%) died. Median duration of ventilation in survivors was 5 days (3-8 d). Fluid overload percent correlated significantly with oxygenation index (Spearman ρ, 0.318; p < 0.0001) and with invasive ventilation days in survivors (Spearman ρ, 0.274; p < 0.0001). There was no significant difference in fluid overload percent between survivors and nonsurvivors. Regression analysis demonstrated that fluid overload percent was a significant predictor of both oxygenation index at 48 hours (p < 0.001) and invasive ventilation days (p = 0.002).
  
  
  CONCLUSIONS
  Fluid overload at 48 hours was associated with oxygenation index at 48 hours and invasive ventilation days in survivors in a general PICU population. There was no association of fluid overload at 48 hours with mortality.
authors.affiliation: 1Paediatric Intensive Care Unit, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, United Kingdom. 2Patient Care & Clinical Informatics, Healthcare, Philips, Guildford, United Kingdom.
authors.forename: Lynn
authors.initials: L
authors.lastname: Sinitsky
authors.forename: David
authors.initials: D
authors.lastname: Walls
authors.forename: Simon
authors.initials: S
authors.lastname: Nadel
authors.forename: David P
authors.initials: DP
authors.lastname: Inwald
mesh_terms: D001826:Body Fluids / Q000187:drug effects*; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality / Q000451:nursing* / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000592:standards; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010100:Oxygen / Q000378:metabolism; D012121:Respiration, Artificial / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010100:Oxygen