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Critical Care Research and Practice
Volume 2011 (2011), Article ID 854142, 5 pages
http://dx.doi.org/10.1155/2011/854142
Research Article

Positive Fluid Balance Is Associated with Higher Mortality and Prolonged Mechanical Ventilation in Pediatric Patients with Acute Lung Injury

1Division of Pediatric Critical Care, Children’s Hospital and Research Center Oakland, 747 52nd Street, Oakland, CA 94609, USA
2Division of Pediatric Pulmonology, UCSF Children’s Hospital, San Francisco, CA 94143, USA
3Division of Nephrology, UCSF Medical Center, San Francisco, CA 94143, USA
4Department of Epidemiology and Biostatistics, CTSI, Children’s Hospital and Research Center Oakland, 747 52nd Street, Oakland, CA 94609, USA
5Department of Anesthesia and Critical Care and CVRI, UCSF Medical Center, San Francisco, CA 94143, USA

Received 25 November 2010; Accepted 1 April 2011

Academic Editor: Ira Cheifetz

Copyright © 2011 Heidi R. Flori et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. We analyzed a database of 320 pediatric patients with acute lung injury (ALI), to test the hypothesis that positive fluid balance is associated with worse clinical outcomes in children with ALI. Methods. This is a post-hoc analysis of previously collected data. Cumulative fluid balance was analyzed in ml per kilogram per day for the first 72 hours after ALI while in the PICU. The primary outcome was mortality; the secondary outcome was ventilator-free days. Results. Positive fluid balance (in increments of 10 mL/kg/24 h) was associated with a significant increase in both mortality and prolonged duration of mechanical ventilation, independent of the presence of multiple organ system failure and the extent of oxygenation defect. These relationships remained unchanged when the subgroup of patients with septic shock ( ) were excluded. Conclusions. Persistently positive fluid balance may be deleterious to pediatric patients with ALI. A confirmatory, prospective randomized controlled trial of fluid management in pediatric patients with ALI is warranted.