Fluid balance in critically ill children with acute lung injury*

• DOI: 10.1097/ccm.0b013e31825bc54d
• Publication Date: 2012-07-21T13:45:28Z
• Authors: Stacey L. Valentine; Anil Sapru; Renee A. Higgerson; Phillip C. Spinella; Heidi R. Flori; Dionne A. Graham; Molly Brett; Maureen Convery; LeeAnn M. Christie; Laurie Karamessinis; Adrienne G. Randolph
• Keywords: Male; Adolescent; Critical Illness; Ventilator-Induced Lung Injury; Respiratory Tract Diseases; Infant, Newborn; Infant; Bayes Theorem; Water-Electrolyte Balance; Intensive Care Units, Pediatric; Pediatrics; 532; 3. Good health; Child, Preschool; Fluid Therapy; Humans; Female; Child; Randomized Controlled Trials as Topic; Retrospective Studies

In the Fluid and Catheter Treatment Trial (NCT00281268), adults with acute lung injury randomized to a conservative vs. liberal fluid management protocol had increased days alive free of mechanical ventilator support (ventilator-free days). Recruiting sufficient children into pediatric trial is challenging. A Bayesian statistical approach relies on adult for priori effect estimate, requiring fewer patients. Preparing mirroring Trial, we aimed to: 1) identify an inverse association between balance ventilator-free days; 2) determine if over time more similar in or arms.Multicentered retrospective cohort study.Five intensive care units.Mechanically ventilated (age≥1 month <18 yrs) admitted 2007-2010.None.Fluid intake, output, net were collected 1-7 168 (median age 3 yrs, median PaO2/FIO2 138) weight-adjusted (mL/kg). Using multivariable linear regression adjust age, gender, race, admission day illness severity, PaO2/FIO2, vasopressor use, increasing cumulative (mL/kg) was associated (p=.02). Adjusted weight, daily 1-3 higher these compared arm (p<.001, each day) arm.Increasing at centers independently days. Our findings similarity patterns our demonstrate need whether strategy improves clinical outcomes Trial.