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J Pediatr Intensive Care
DOI: 10.1055/s-0042-1757480
Original Article

Fluid Overload in Pediatric Acute Respiratory Distress Syndrome after Allogeneic Hematopoietic Cell Transplantation

Colin J. Sallee 
1   Department of Pediatrics, Division of Pediatric Critical Care, UCLA Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California, United States
,
Julie C. Fitzgerald
2   Department of Anesthesiology and Critical Care, Division of Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Lincoln S. Smith
3   Department of Pediatrics, Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington, Seattle, Washington, United States
,
Joseph R. Angelo
4   Department of Pediatrics, Renal Section, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, United States
,
Megan C. Daniel
5   Department of Pediatrics, Division of Critical Care, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, United States
,
Shira J. Gertz
6   Department of Pediatrics, Division of Pediatric Critical Care, Saint Barnabas Medical Center, Livingston, New Jersey, United States
,
Deyin D. Hsing
7   Department of Pediatrics, Division of Critical Care, Weil Cornell Medical College, New York Presbyterian Hospital, New York City, New York, United States
,
Kris M. Mahadeo
8   Department of Pediatrics, Pediatric Stem Cell Transplantation and Cellular Therapy, Children's Cancer Hospital, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
,
Jennifer A. McArthur
9   Department of Pediatrics, Division of Critical Care, St Jude Children's Research Hospital, Memphis, Tennessee, United States
,
Courtney M. Rowan
10   Department of Pediatrics, Division of Critical Care, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, United States
,
on behalf of the Pediatric Acute Lung Injury Sepsis Investigators (PALISI) Network › Author Affiliations Funding J.F. is supported by NIH NIDDK K23 DK119463. C.R. is supported by NIH NHLBI K23 HL150244.
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Abstract

The aim of the study is to examine the relationship between fluid overload (FO) and severity of respiratory dysfunction in children post-hematopoietic cell transplantation (HCT) with pediatric acute respiratory distress syndrome (PARDS). This investigation was a secondary analysis of a multicenter retrospective cohort of children (1month to 21 years) post-allogeneic HCT with PARDS receiving invasive mechanical ventilation (IMV) from 2009 to 2014. Daily FO % (FO%) and daily oxygenation index (OI) were calculated for each patient up to the first week of IMV (day 0 = intubation). Linear mixed-effect regression was employed to examine whether FO% and OI were associated on any day during the study period. In total, 158 patients were included. Severe PARDS represented 63% of the cohort and had higher mortality (78 vs. 42%, p <0.001), fewer ventilator free days at 28 (0 [IQR 0–0] vs. 14 [IQR 0–23], p <0.001), and 60 days (0 [IQR 0–27] v. 45 [IQR 0–55], p <0.001) relative to non-severe PARDS. Increasing FO% was strongly associated with higher OI (p <0.001). For children with 10% FO, OI was higher by nearly 5 points (adjusted β 4.6, 95% CI [2.9, 6.3]). In subgroup analyses, the association between FO% and OI was strongest among severe PARDS (p <0.001) and during the first 3 days elapsed from intubation (p <0.001). FO% was associated with lower PaO2/FiO2 (adjusted β −1.92, 95% CI [−3.11, −0.73], p = 0.002), but not mean airway pressure (p = 0.746). In a multicenter cohort of children post-HCT with PARDS, FO was independently associated with oxygenation impairment. The associations were strongest among children with severe PARDS and early in the course of IMV.

Keywords

pediatric acute respiratory distress syndrome - fluid overload - hematopoietic cell transplantation - mechanical ventilation


Publication History

Received: 13 March 2022

Accepted: 23 August 2022

Article published online:
11 October 2022

© 2022. Thieme. All rights reserved.

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