LIÊN QUAN GIỮA QUÁ TẢI DỊCH TỚI KẾT QUẢ ĐIỀU TRỊ TRẺ DƯỚI 36 THÁNG TUỔI CẦN THỞ MÁY TẠI BỆNH VIỆN NHI TRUNG ƯƠNG

Abstract

Fluid Overload (FO) is prevalent among critically ill children in pediatric intensive care unit (PICU). Recent studies suggest that fluid overload increases the risk of mortality, the need for renal replacement therapy, and prolonged mechanical ventilation. Objectives: To determine the relationship between fluid overload and treatment outcomes among children aged less than 36 months who required invasive mechanical ventilation in the PICU of Vietnam National Children's Hospital. Methods: A prospective descriptive study. We enrolled 245 patients aged from 1 to 36 months requiring invasive mechanical ventilation for more than 24 hours. Clinical data were collected on PICU admisison untill 7 days post PICU admission. All patients were until discharge from the PICU or day 28 in the PICU. Multivariate logistic regression was applied to identify predictors for mortality. Results: 44% patients had fluid overload during 7 days of PICU admission (FO ≥ 5%). Among those patients, 20% had FO ≥ 10%; 9% had FO ≥ 15%.  71 (29,0%) patients died. The odds of death increased with the degree of fluid overload, with a statistically significant difference (p < 0.008). Severe fluid overload increased the risk of renal replacement therapy by 3.2 times compared to patients without or with mild fluid overload, with a statistically significant difference (p = 0.03, 95% CI = 1.1–9.2). Patients with severe fluid overload had a 49% longer duration of mechanical ventilation (exp(0.4) = 1.49), with a statistically significant difference (p = 0.001). Conclusions: FO was a common condition that negatively impacts treatment outcomes in children under 36 months of age who require mechanical ventilation in the PICU.