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- Title
Fluid Balance Is Associated with Clinical Outcomes and Extravascular Lung Water in Children with Acute Asthma Exacerbation.
- Authors
Kantor, David B.; Hirshberg, Eliotte L.; McDonald, Molly C.; Griffin, John; Buccigrosso, Tess; Stenquist, Nicole; Smallwood, Craig D.; Nelson, Kyle A.; Zurakowski, David; Phipatanakul, Wanda; Hirschhorn, Joel N.
- Abstract
<bold>Rationale: </bold>The effects of fluid administration during acute asthma exacerbation are likely unique in this patient population: highly negative inspiratory intrapleural pressure resulting from increased airway resistance may interact with excess fluid administration to favor the accumulation of extravascular lung water, leading to worse clinical outcomes.<bold>Objectives: </bold>Investigate how fluid balance influences clinical outcomes in children hospitalized for asthma exacerbation.<bold>Methods: </bold>We analyzed the association between fluid overload and clinical outcomes in a retrospective cohort of children admitted to an urban children's hospital with acute asthma exacerbation. These findings were validated in two cohorts: a matched retrospective and a prospective observational cohort. Finally, ultrasound imaging was used to identify extravascular lung water and investigate the physiological basis for the inferential findings.<bold>Measurements and Main Results: </bold>In the retrospective cohort, peak fluid overload [(fluid input - output)/weight] is associated with longer hospital length of stay, longer treatment duration, and increased risk of supplemental oxygen use (P values < 0.001). Similar results were obtained in the validation cohorts. There was a strong interaction between fluid balance and intrapleural pressure: the combination of positive fluid balance and highly negative inspiratory intrapleural pressures is associated with signs of increased extravascular lung water (P < 0.001), longer length of stay (P = 0.01), longer treatment duration (P = 0.03), and increased risk of supplemental oxygen use (P = 0.02).<bold>Conclusions: </bold>Excess volume administration leading to fluid overload in children with acute asthma exacerbation is associated with increased extravascular lung water and worse clinical outcomes.
- Publication
American Journal of Respiratory & Critical Care Medicine, 2018, Vol 197, Issue 9, p1128
- ISSN
1073-449X
- Publication type
journal article
- DOI
10.1164/rccm.201709-1860OC