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Am J Respir Crit Care Med. 2018 May 1;197(9):1128-1135. doi: 10.1164/rccm.201709-1860OC.

Fluid Balance Is Associated with Clinical Outcomes and Extravascular Lung Water in Children with Acute Asthma Exacerbation.

Author information

1
1 Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine.
2
2 Department of Anaesthesia.
3
3 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Intermountain Medical Center, Murray, Utah.
4
4 Department of Pediatrics, Division of Pediatric Critical Care, University of Utah, Salt Lake City, Utah; and.
5
5 Clinical Research Center.
6
6 Division of Pediatric Emergency Medicine.
7
7 Department of Pediatrics, and.
8
8 Division of Allergy and Immunology, and.
9
9 Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts.
10
11 Department of Genetics, Harvard Medical School, Boston, Massachusetts.
11
10 Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts.

Abstract

RATIONALE:

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.

OBJECTIVES:

Investigate how fluid balance influences clinical outcomes in children hospitalized for asthma exacerbation.

METHODS:

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.

MEASUREMENTS AND MAIN RESULTS:

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).

CONCLUSIONS:

Excess volume administration leading to fluid overload in children with acute asthma exacerbation is associated with increased extravascular lung water and worse clinical outcomes.

KEYWORDS:

asthma exacerbation; extravascular lung water; intrapleural pressure; severe asthma

PMID:
29313715
PMCID:
PMC6019929
DOI:
10.1164/rccm.201709-1860OC
[Indexed for MEDLINE]
Free PMC Article

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