title: Fluid balance and length of mechanical ventilation in children admitted to a single Pediatric Intensive Care Unit.
abstract: BACKGROUND
  Associations between cumulative fluid balance and a prolonged duration of assisted mechanical ventilation have been described in adults. The aim of this study was to evaluate whether fluid balance in the first 48 hours of assisted mechanical ventilation initiation was associated with a prolonged duration of this process among children in the Pediatric Intensive Care Unit (PICU).
  
  
  METHODS
  Retrospective cohort of patients in the PICU o, Hospital Italiano de Buenos Aires, between 1/1/2010 and 6/30/2012. Balance was calculated in percentage of body weight; prolonged mechanical ventilation was defined as >7 days, and confounders were registered. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  Two hundred and forty-nine patients were mechanically ventilated for over 48 hours; 163 were included in the study. Balance during the first 48 hours of mechanical ventilation was 5.7% ± 5.86; 82 patients (50.3%) were on mechanical ventilation for more than 7 days. Age 〈 4 years old (OR 3.21, 95% CI 1.38-7.48, p 0.007), respiratory disease (OR 4.94, 95% CI 1.51-16.10, p 0.008), septic shock (OR 4.66, 95% CI 1.10-19.65, p 0.036), Pediatric Logistic Organ Dysfunction (PELOD) 〉 10 (OR 2.44, 95% CI 1.234.85, p 0.011), and positive balance 〉 13% (OR 4.02, 95% CI 1.08-15.02, p 0.038) were associated with prolonged mechanical ventilation. The multivariate model resulted in an OR 2.58, 95% CI: 1.17-5.58, p= 0.018 for PELOD 〉 10, and an OR 3.7, 95% CI: 0.91-14.94, p= 0.066 for positive balance 〉 13%.
  
  
  CONCLUSIONS
  Regarding prolonged mechanical ventilation, the multivariate model showed an independent association with organ dysfunction (PELOD 〉 10) and a trend towards an association with positive balance 〉 13%.
authors.affiliation: Servicio de Terapia Intensiva Pediátrica, Hospital Italiano, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Solange
authors.initials: S
authors.lastname: Vidal
authors.affiliation: Servicio de Terapia Intensiva Pediátrica, Hospital Italiano, Ciudad Autónoma de Buenos Aires, Argentina.
authors.forename: Augusto
authors.initials: A
authors.lastname: Pérez
authors.affiliation: Servicio de Terapia Intensiva Pediátrica, Hospital Italiano, Ciudad Autónoma de Buenos Aires, Argentina. pablo.eulmesekian@hospitalitaliano.org.ar.
authors.forename: Pablo
authors.initials: P
authors.lastname: Eulmesekian
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D010343:Patient Admission; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D014882:Water-Electrolyte Balance
keywords: Children; Fluid balance; Mechanical ventilation; Pediatric intensive care units