期刊
CRITICAL CARE MEDICINE
卷 40, 期 10, 页码 2883-2889出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CCM.0b013e31825bc54d
关键词
acute lung injury; acute respiratory distress syndrome; children; critical illness; fluid; fluid balance; mechanical ventilation
资金
- National Research Service Award Ruth T. Kirschstein Award
- Agency for Healthcare Research and Quality [T32 HS000063]
- Harvard Pediatric Health Services Research Fellowship Program
- National Institute of Child Health and Human Development [HD047349]
- National Heart, Lung, and Blood Institute [K23 HL085526]
- Harvard Catalyst
- Harvard Clinical and Translational Science Center (National Institutes of Health Award from Harvard University) [UL1 RR 025758]
Objectives: 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 and free of mechanical ventilator support (ventilator-free days). Recruiting sufficient children with acute lung injury into a pediatric trial is challenging. A Bayesian statistical approach relies on the adult trial for the a priori effect estimate, requiring fewer patients. Preparing for a Bayesian pediatric trial mirroring the Fluid and Catheter Treatment Trial, we aimed to: 1) identify an inverse association between fluid balance and ventilator-free days; and 2) determine if fluid balance over time is more similar to adults in the Fluid and Catheter Treatment Trial liberal or conservative arms. Design: Multicentered retrospective cohort study. Setting: Five pediatric intensive care units. Patients: Mechanically ventilated children (age >= 1 month to <18 yrs) with acute lung injury admitted in 2007-2010. Interventions: None. Measurements and Main Results: Fluid intake, output, and net fluid balance were collected on days 1-7 in 168 children with acute lung injury (median age 3 yrs, median Pao(2)/Fio(2) 138) and weight-adjusted (mL/kg). Using multivariable linear regression to adjust for age, gender, race, admission day illness severity, Pao(2)/Fio(2), and vasopressor use, increasing cumulative fluid balance (mL/kg) on day 3 was associated with fewer ventilator-free days (p = .02). Adjusted for weight, daily fluid balance on days 1-3 and cumulative fluid balance on days 1-7 were higher in these children compared to adults in the Fluid and Catheter Treatment Trial conservative arm (p < .001, each day) and was similar to adults in the liberal arm. Conclusions: Increasing fluid balance on day 3 in children with acute lung injury at these centers is independently associated with fewer ventilator-free days. Our findings and the similarity of fluid balance patterns in our cohort to adults in the Fluid and Catheter Treatment Trial liberal arm demonstrate the need to determine whether a conservative fluid management strategy improves clinical outcomes in children with acute lung injury and support a Bayesian trial mirroring the Fluid and Catheter Treatment Trial. (Crit Care Med 2012; 40:2883-2889)
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