title: Early Fluid Overload Prolongs Mechanical Ventilation in Children With Viral-Lower Respiratory Tract Disease.
abstract: OBJECTIVE
  Viral-lower respiratory tract disease is common in young children worldwide and is associated with high morbidity. Acute respiratory failure due to viral-lower respiratory tract disease necessitates PICU admission for mechanical ventilation. In critically ill patients in PICU settings, early fluid overload is common and associated with adverse outcomes such as prolonged mechanical ventilation and increased mortality. It is unclear, however, if this also applies to young children with viral-lower respiratory tract disease induced acute respiratory failure. In this study, we aimed to investigate the relation of early fluid overload with adverse outcomes in mechanically ventilated children with viral-lower respiratory tract disease in a retrospective dataset.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Single, tertiary referral PICU.
  
  
  METHODS
  One hundred thirty-five children (< 2 yr old) with viral-lower respiratory tract disease requiring mechanical ventilation admitted to the PICU of the Academic Medical Center, Amsterdam between 2008 and 2014.
  
  
  METHODS
  None.
  
  
  RESULTS
  The cumulative fluid balance on day 3 of mechanical ventilation was compared against duration of mechanical ventilation (primary outcome) and daily mean oxygen saturation index (secondary outcome), using uni- and multivariable linear regression. In 132 children, the mean cumulative fluid balance on day 3 was + 97.9 (49.2) mL/kg. Higher cumulative fluid balance on day 3 was associated with a longer duration of mechanical ventilation in multivariable linear regression (β = 0.166; p = 0.048). No association was found between the fluid status and oxygen saturation index during the period of mechanical ventilation.
  
  
  CONCLUSIONS
  Early fluid overload is an independent predictor of prolonged mechanical ventilation in young children with viral-lower respiratory tract disease. This study suggests that avoiding early fluid overload is a potential target to reduce duration of mechanical ventilation in these children. Prospective testing in a clinical trial is warranted to support this hypothesis.
authors.affiliation: All authors: Department of Pediatric Intensive Care, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Ingelse
authors.forename: Hanke M G
authors.initials: HM
authors.lastname: Wiegers
authors.forename: Job C
authors.initials: JC
authors.lastname: Calis
authors.forename: Job B
authors.initials: JB
authors.lastname: van Woensel
authors.forename: Reinout A
authors.initials: RA
authors.lastname: Bem
mesh_terms: D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016014:Linear Models; D008297:Male; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000150:complications / Q000628:therapy* / Q000821:virology; D012141:Respiratory Tract Infections / Q000150:complications / Q000628:therapy* / Q000821:virology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014777:Virus Diseases / Q000150:complications / Q000628:therapy*; D014883:Water-Electrolyte Imbalance / Q000209:etiology*