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Abstract

Introduction: Fluid overload (FO) is a common problem in critically ill children and has been associated with adverse outcomes. However, the impact of fluid accumulation occurring during early phase of critical illness is not known. Methods: We performed a retrospective chart review of children admitted to a tertiary level pediatric ICU over a 7 month period to identify a cohort of patients with sepsis and/or shock requiring an ICU stay > 2 days. 'Early FO' was defined as cumulative fluid accumulation ≥ 10% of admission body weight during the initial 3 days of ICU stay. Children with 'early FO' in the cohort were designated as 'cases'. Matched 'controls' without 'early FO' were selected from the same cohort by matching for age, severity of illness, respiratory failure, shock and extra-corporeal life support (ECLS), using a 'nearest neighbor' matching algorithm. Cases and controls were compared with respect to ICU mortality. Results: A total of 114 children were in the cohort. Of these, 35 children had 'early FO' (mortality 31%) and 79 did not have 'early FO' (mortality 5%). 34 'cases' and 34 matched 'controls' nested in this cohort were selected. 'Cases' differed significantly from 'controls' with respect mortality (32% vs. 3%, p < 0.0001). They did not differ significantly with respect to other covariates including age, gender, primary diagnoses, reason for ICU admission, presence of oncologic diagnosis and presence of respiratory failure and shock. However, 10 of the 34 'cases' required ECLS as compared to only 1 of the 34 'controls'. Hence a sub-group analysis of non-ECLS children was performed to compare 24 'cases' with 24 matched 'controls'. The difference in mortality between 'cases' and 'controls' continued to be significant in the non-ECLS children (17% vs. 0%, p 0.03). Conclusions: In our cohort of critically ill children, 'early FO' was associated with higher ICU mortality. Future studies prospectively evaluating the association between fluid accumulation patterns and outcomes are required to understand the impact of fluid kinetics.