Pattern of Fluid Overload and its Impact on Mortality Among Mechanically Ventilated Children: Secondary Analysis of the ReLiSCh Trial

To assess the pattern of fluid overload (FO) and its impact on mortality among mechanically ventilated children.

In this secondary analysis of an open-label randomized controlled trial (ReLiSCh trial, October 2020-September 2021), hemodynamically stable mechanically ventilated children (n = 100) admitted to a tertiary level pediatric intensive care unit (PICU) in North India were enrolled. The primary outcome was pattern of FO (FO% >10% and cumulative FO% from day 1–7); and secondary outcomes were pattern of FO among survivors and non-survivors, and prescription practices of maintenance fluid.

The median (IQR) age was 3.5 (0.85–7.5) y and 57% were males. Common diagnoses were pneumonia (27%), scrub typhus (14%), Landry-Guillain-Barré syndrome (9%), dengue (8%), central nervous system infections (7%) and staphylococcal sepsis (6%). Common organ dysfunction included acute respiratory distress syndrome (ARDS) (41%), shock (38%), and acute kidney injury (AKI) (9%). The duration PICU stay was 11 (7–17) d and mortality was 12%. The FO% >10% was noted in 19% children; and there was significant increase in cumulative FO% from day 1–7 [1.2 (0.2–2.6)% to 8.5 (1.7–14.3)%, (p = 0.000)]. Among non-survivors, higher proportion had FO% >10% (66.7% vs. 12.5%, p 0.0001); and trend towards higher cumulative FO% on first seven days. From day 1–7, the percentage of maintenance fluid received increased from 60 (50–71)% to 70 (60–77)% (p = 0.691).

One-fifth of mechanically ventilated children had FO% >10% and there was significant increase in cumulative FO% from day 1–7. Non-survivors had significantly higher degree of FO.