Ravi Piryani, MBA
PICU Fellow
State University of New York Buffalo JSMBS
Buffalo
Disclosure information not submitted.
Cynthia Alvarez
Pediatric Resident
Rush University, United States
Disclosure information not submitted.
Andrew Nordin
Pediatric Surgery Fellow
University of Buffalo, United States
Disclosure information not submitted.
Kathryn Bass, MD, MBA
Director, Level 1 Pediatric Trauma Center
Oishei Children's Hospital, Buffalo NY, United States
Disclosure information not submitted.
Brian Wrotniak, PhD
Mr.
Department of Pediatrics, John R. Oishei Children’s Hospital, Buffalo, New York, USA, United States
Disclosure information not submitted.
Cathleen Ducato
Surgery Resident
University of Buffalo, United States
Disclosure information not submitted.
Bree Kramer
Pediatric Critical Care Attending
University of Buffalo, United States
Disclosure information not submitted.
Anil Swayampakula, MD MPH
Attending Physician
Oishei Children's Hospital, Buffalo NY, United States
Disclosure information not submitted.
Title: Fluid overload is associated with prolonged admission in critically ill pediatric trauma patients
Introduction: Higher fluid overload percentage is associated with worse outcomes in critically ill children. However, there are no known studies focusing on this association in pediatric trauma patients. The purpose of our study was to investigate the association between fluid overload and mortality, ICU length of stay (LOS), and hospital LOS in pediatric trauma patients.
Methods: This retrospective cohort study was conducted at a single tertiary PICU. All activated traumas (N=373) aged 0-21 years admitted from our ED to PICU between January 2014 and December 2020 included in our hospital trauma database were eligible. Patients with pre-existing renal conditions and diuretic dependence were excluded. Data collected included demographics, Injury Severity Score (ISS), diagnosis, fluid overload percentage (FO%) at 48 hours from admission to PICU. FO% was calculated as cumulative in-cumulative out in liter/hospital admission weight (kg) x 100%. All patients were categorized into < 10 and >= 10 FO%. Outcomes measures included mortality; and ICU LOS, hospital LOS and mechanical ventilation in survivors. Pearson's chi-squared test was used to assess the association between categorical variables. All analyses were conducted with SYSTAT 13 (SYSTAT Software, 2004).
Results: Median age was 6 years (0-19). Sixteen patients (4.3%) died. Among survivors, patients with >=10FO% had significantly higher ICU LOS (days) (5.8 vs 4.0, p=0.006), hospital LOS (days) (12.7 vs 6.6, p< 0.001) and ISS (17 vs 13.4, p=0.001) than those with FO% < 10. There was no significant difference in mechanical ventilation days between the two groups. There was no significant difference in FO% between survivors and non-survivors. Higher ISS, need for vasopressors and non-accidental trauma were significant predictors of mortality. Patients admitted under neurosurgery service and those with head injury were more likely to have FO% >=10.
Conclusion: Fluid overload >=10% at 48 hours after admission to PICU was associated with increased ICU and hospital LOS in pediatric trauma patients. However, there was no significant difference in mortality. Our findings suggest a need to closely monitor fluid balance to ensure optimal outcomes in this population.