Klinik Araştırma
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Kritik Hasta Çocuklarda Sıvı Birikimi İkilemi, Retrospektif Bir Çalışma

Yıl 2022, Cilt 12, Sayı 5, 799 - 803, 30.09.2022
https://doi.org/10.16899/jcm.1146499

Öz

Amaç: Çocuk yoğun bakım ünitelerinde (ÇYBÜ) hastalarda sıvı birikimi meydana gelmektedir. Çocuk yoğun bakım ünitelerinde uygulanan ilaçlar, hastalarda önemli kümülatif sıvı yüküne katkıda bulunabilir. Bu çalışmada akut böbrek yetmezliği (AKI) olmayan hastalarda sıvı birikimini araştırmayı ve ilaçların sıvı alımına katkısını belirlemeyi amaçladık. Gereç ve Yöntem: Bu çalışmada 101 hastaya ait 527 adet günlük takip formu geriye dönük olarak incelendi. Bulgular: Komorbiditesi olan, invaziv mekanik ventilasyon uygulanan ve inotrop ihtiyacı olan hastalarda toplam sıvı yükü daha yüksek bulundu. Sepsisli hastalarda sıvı yükü diğer tanı gruplarına göre daha yüksek iken, çocuklarda multisistem inflamatuar sendromlu hastalarda (MIS-C) anlamlı olarak daha düşüktü. Kümülatif sıvı yükü medyan (IQR) ilk 5 günde %11,6 (7,1-16,4) iken 10. günde medyan (IQR) %25,7'ye (14,65-34,1) ulaştı. Hastanın takip günleri arttıkça kümülatif sıvı yükü arttı. Tek başına ilaçlardan ortalama günlük sıvı alımı (IQR) %14,48 (8,07-24,13) idi. İlaçların toplam sıvı yüküne katkısı hastaların yaşı azaldıkça arttı (r: -0,164, p< 0,001). Sonuç: AKI'si olmayan ÇYBÜ hastalarında kümülatif sıvı yükü oluşur. Özellikle küçük çocuklarda ilaçla birlikte verilen sıvıların sıvı yüküne katkısı akılda tutulmalıdır. Klinisyenler sıvı birikimi-sıvı aşırı yüklenmesi ikileminden kurtulmak için sıvı durum değerlendirmelerini objektif kriterlerle destekleyerek hastaya özel sıvı yönetimi yapmalıdır.

Kaynakça

  • Raina R, Sethi SK, Wadhwani N, Vemuganti M, Krishnappa V, Bansal SB. Fluid Overload in Critically Ill Children. Front Pediatr 2018;6:306.
  • Alobaidi R, Basu RK, DeCaen A, et al. Fluid Accumulation in Critically Ill Children. Crit Care Med 2020;48(7):1034-41.
  • Sutherland SM, Zappitelli M, Alexander SR, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis 2010;55(2):316-25.
  • Bouchard JE, Mehta RL. Fluid balance issues in the critically ill patient. Contrib Nephrol 2010;164:69-78.
  • Fuhrman D, Crowley K, Vetterly C, Hoshitsuki K, Koval A, Carcillo J. Medication Use as a Contributor to Fluid Overload in the PICU: A Prospective Observational Study. J Pediatr Intensive Care 2018;7(2):69-74.
  • Lima L, Menon S, Goldstein SL, Basu RK. Timing of Fluid Overload and Association With Patient Outcome. Pediatr Crit Care Med 2021;22(1):114-24.
  • Alobaidi R, Morgan C, Basu RK, et al. Association Between Fluid Balance and Outcomes in Critically Ill Children: A Systematic Review and Meta-analysis. JAMA Pediatr 2018;172(3):257-68.
  • Payen D, de Pont AC, Sakr Y, et al. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care 2008;12(3):R74.
  • Arikan AA, Zappitelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med 2012;13(3):253-8.
  • Lee J, de Louw E, Niemi M, et al. Association between fluid balance and survival in critically ill patients. J Intern Med 2015;277(4):468-77.
  • Gillespie RS, Seidel K, Symons JM. Effect of fluid overload and dose of replacement fluid on survival in hemofiltration. Pediatr Nephrol 2004;19(12):1394-9.
  • Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL; AWARE Investigators. Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N Engl J Med 2017;376(1):11-20.
  • Goldstein SL, Somers MJ, Baum MA, et al. Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int 2005;67(2):653-8.
  • Goldstein SL, Somers MJ, Baum MA, et al. Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int 2005;67(2):653-8.
  • Selewski DT, Cornell TT, Lombel RM, et al. Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy. Intensive Care Med 2011;37(7):1166-73.
  • Favia I, Garisto C, Rossi E, Picardo S, Ricci Z. Fluid management in pediatric intensive care. Contrib Nephrol 2010;164:217-26.
  • Luciani R, Goracci M, Simon C, et al. Reduction of Early Postoperative Morbidity in Cardiac Surgery Patients Treated With Continuous Veno–Venous Hemofiltration During Cardiopulmonary Bypass. Artif Organs 2009;33(8):654-7.
  • Elahi M, Asopa S, Pflueger A, Hakim N, Matata B. Acute kidney injury following cardiac surgery: impact of early versus late haemofiltration on morbidity and mortality. Eur J Cardiothorac Surg 2009;35(5):854-63.
  • Bouchard J, Soroko SB, Chertow GM, et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int 2009;76(4):422-7.
  • Mehta RL, Pascual MT, Soroko S, Chertow GM; PICARD Study Group. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 2002;288(20):2547-53.
  • Delmonaco AG, Carpino A, Raffaldi I, et al. First diagnosis of multisystem inflammatory syndrome in children (MIS-C): an analysis of PoCUS findings in the ED. Ultrasound J 2021;13(1):41.
  • Connor-Schuler R, Suarez J. POCUS in Intensive Care Nephrology. POCUS J 2022;7:51–8.
  • Raman S, Peters MJ. Fluid management in the critically ill child. Pediatr Nephrol 2014;29(1):23-34.
  • Claure-Del Granado R, Mehta RL. Fluid overload in the ICU: evaluation and management. BMC Nephrol 2016;17(1):109.
  • Emeksiz S, Çelikel Acar B, Kibar AE, et al. Algorithm for the diagnosis and management of the multisystem inflammatory syndrome in children associated with COVID-19. Int J Clin Pract 2021;75(9):e14471.

Fluid Accumulation Dilemma in the Critically Ill Children, A Retrospective Study

Yıl 2022, Cilt 12, Sayı 5, 799 - 803, 30.09.2022
https://doi.org/10.16899/jcm.1146499

Öz

Aim: Fluid accumulation occurs in pediatric patients in pediatric intensive care units (PICU). Medications administered in pediatric intensive care units can contribute to significant cumulative load in patients. In present study, we aimed to study fluid accumulation on patients without AKI and to determine contribution of medications over fluid intake. Material and Method: In this study, 527 daily follow-up forms of 101 patients was investigated retrospectively. Results: Total fluid load was found to be higher in patients with comorbidities, who underwent invasive mechanical ventilation, and who needed inotropes. While fluid load was higher in patients with sepsis than in other diagnostic groups, it was significantly lower in patients with multisystem inflammatory syndrome in children (MIS-C). While the median (IQR) of the cumulative fluid load was 11.6% (7.1-16.4) in the first 5 days, the median (IQR) reached 25.7% (14.65-34.1) on the 10th day. The cumulative fluid load increased as the patient's follow-up days increased. The median average daily fluid intake (IQR) from drugs alone was 14.48% (8.07-24.13). The contribution of drugs to the total fluid load increased as the age of patients decreased (r: -0.164, p< 0.001). Conclusion: A cumulative fluid load occurs in PICU patients without AKI. Particularly in young children, the contribution of fluids given with drugs to the fluid load should be kept in mind. Clinicians should perform patient-specific fluid management by supporting fluid status assessments with objective criteria in order to get out of the fluid accumulation- fluid over load dilemma.

Kaynakça

  • Raina R, Sethi SK, Wadhwani N, Vemuganti M, Krishnappa V, Bansal SB. Fluid Overload in Critically Ill Children. Front Pediatr 2018;6:306.
  • Alobaidi R, Basu RK, DeCaen A, et al. Fluid Accumulation in Critically Ill Children. Crit Care Med 2020;48(7):1034-41.
  • Sutherland SM, Zappitelli M, Alexander SR, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis 2010;55(2):316-25.
  • Bouchard JE, Mehta RL. Fluid balance issues in the critically ill patient. Contrib Nephrol 2010;164:69-78.
  • Fuhrman D, Crowley K, Vetterly C, Hoshitsuki K, Koval A, Carcillo J. Medication Use as a Contributor to Fluid Overload in the PICU: A Prospective Observational Study. J Pediatr Intensive Care 2018;7(2):69-74.
  • Lima L, Menon S, Goldstein SL, Basu RK. Timing of Fluid Overload and Association With Patient Outcome. Pediatr Crit Care Med 2021;22(1):114-24.
  • Alobaidi R, Morgan C, Basu RK, et al. Association Between Fluid Balance and Outcomes in Critically Ill Children: A Systematic Review and Meta-analysis. JAMA Pediatr 2018;172(3):257-68.
  • Payen D, de Pont AC, Sakr Y, et al. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care 2008;12(3):R74.
  • Arikan AA, Zappitelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med 2012;13(3):253-8.
  • Lee J, de Louw E, Niemi M, et al. Association between fluid balance and survival in critically ill patients. J Intern Med 2015;277(4):468-77.
  • Gillespie RS, Seidel K, Symons JM. Effect of fluid overload and dose of replacement fluid on survival in hemofiltration. Pediatr Nephrol 2004;19(12):1394-9.
  • Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL; AWARE Investigators. Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N Engl J Med 2017;376(1):11-20.
  • Goldstein SL, Somers MJ, Baum MA, et al. Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int 2005;67(2):653-8.
  • Goldstein SL, Somers MJ, Baum MA, et al. Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int 2005;67(2):653-8.
  • Selewski DT, Cornell TT, Lombel RM, et al. Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy. Intensive Care Med 2011;37(7):1166-73.
  • Favia I, Garisto C, Rossi E, Picardo S, Ricci Z. Fluid management in pediatric intensive care. Contrib Nephrol 2010;164:217-26.
  • Luciani R, Goracci M, Simon C, et al. Reduction of Early Postoperative Morbidity in Cardiac Surgery Patients Treated With Continuous Veno–Venous Hemofiltration During Cardiopulmonary Bypass. Artif Organs 2009;33(8):654-7.
  • Elahi M, Asopa S, Pflueger A, Hakim N, Matata B. Acute kidney injury following cardiac surgery: impact of early versus late haemofiltration on morbidity and mortality. Eur J Cardiothorac Surg 2009;35(5):854-63.
  • Bouchard J, Soroko SB, Chertow GM, et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int 2009;76(4):422-7.
  • Mehta RL, Pascual MT, Soroko S, Chertow GM; PICARD Study Group. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 2002;288(20):2547-53.
  • Delmonaco AG, Carpino A, Raffaldi I, et al. First diagnosis of multisystem inflammatory syndrome in children (MIS-C): an analysis of PoCUS findings in the ED. Ultrasound J 2021;13(1):41.
  • Connor-Schuler R, Suarez J. POCUS in Intensive Care Nephrology. POCUS J 2022;7:51–8.
  • Raman S, Peters MJ. Fluid management in the critically ill child. Pediatr Nephrol 2014;29(1):23-34.
  • Claure-Del Granado R, Mehta RL. Fluid overload in the ICU: evaluation and management. BMC Nephrol 2016;17(1):109.
  • Emeksiz S, Çelikel Acar B, Kibar AE, et al. Algorithm for the diagnosis and management of the multisystem inflammatory syndrome in children associated with COVID-19. Int J Clin Pract 2021;75(9):e14471.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Orjinal Araştırma
Yazarlar

Emel UYAR> (Sorumlu Yazar)
Ankara Şehir Hastanesi
0000-0002-8265-0618
Türkiye


Ahmet Alptuğ GÜNGÖR>
Ankara Şehir Hastanesi
0000-0002-7956-5826
Türkiye


Oktay PERK>
Ankara Şehir Hastanesi
0000-0002-2586-5954
Türkiye


Serhan ÖZCAN>
Ankara Şehir Hastanesi
0000-0003-4465-6063
Türkiye


Esra KOÇKUZU>
Ankara Şehir Hastanesi
0000-0002-5760-349X
Türkiye


Serhat EMEKSİZ>
YILDIRIM BEYAZIT ÜNİVERSİTESİ
0000-0002-8951-4774
Türkiye

Erken Görünüm Tarihi 11 Temmuz 2022
Yayımlanma Tarihi 30 Eylül 2022
Kabul Tarihi 19 Eylül 2022
Yayınlandığı Sayı Yıl 2022, Cilt 12, Sayı 5

Kaynak Göster

AMA Uyar E. , Güngör A. A. , Perk O. , Özcan S. , Koçkuzu E. , Emeksiz S. Fluid Accumulation Dilemma in the Critically Ill Children, A Retrospective Study. J Contemp Med. 2022; 12(5): 799-803.