Background

Positive fluid balance is correlated with worse outcomes in pediatric acute respiratory distress syndrome(PARDS). However, there is scarce data on the prognosis affected by positive intake along with the time period. We aimed to determine the trend of daily and cumulative fluid management practices, and the relationship between the timing of fluid overload and clinical outcomes in PARDS.

Methods

The study included 320 children who needed invasive mechanical ventilation and were diagnosed with PARDS according to the oxygenation index of Pediatric Acute Lung Injury Consensus Conference definition from June 2009 to March 2021. Daily and cumulative total intake, output, and balance data were retrospectively collected from day 1 to 7 after PARDS onset.

Results

The daily and cumulative total intake decreased over the study period. In multivariable analysis, the positive fluid intakes on day 6 and 7 were significantly associated with increased mortality (OR [95% CI]; 1.019 [1.006-1.031] P = 0.003, and 1.022 [1.009-1.035] P = 0.001, respectively). The more fluid intake on day 1, the less ventilator-free days (VFDs) (? = -0.030, P = 0.002). Cumulative positive fluid balance in the early period (through day 3 and day 4)considerably correlated with increased mortality (OR [95% CI]; 1.007 [1.002-1.012], P = 0.005, respectively) and with decreased VFDs (? = -0.026, P = 0.002).

Conclusions

Positive fluid balance during the acute phase in PARDS is greatly associated with increased mortality and decreased VFDs. Moreover, the increased fluid intake itself is related to adverse outcomes in PARDS.