Dados do Trabalho

Título

Fluid accumulation in critically ill children: a systematic review and meta-analysis

Objetivo

To assess the impact of fluid accumulation (FA) in critically ill children.

Métodos

Pubmed, EMBASE and Cochrane Library electronic databases were searched from inception to May 2023. Language was restricted to English and Spanish. Studies were considered eligible if they included patients from 28 days to 18 years old and reported an association between FA and the following outcomes: mortality, duration of invasive mechanical ventilation, organ dysfunction, length of stay (LOS) in PICU and hospital. Pooled analyses were performed by using random-effects models. This review was registered at PROSPERO database (CRD42023432879).

Resultados

A total of 103 studies (25,023 children) were included. FA was associated with increased mortality, higher incidence of acute kidney injury, prolonged mechanical ventilation, and longer LOS in the PICU and hospital. Forty-one studies were included in the meta-analysis of mortality (33.209 cases) and 30 categorical definitions of FA were identified. In general, FA was associated with increased mortality (odds ratio [OR] 5.78; 95% confidence interval [95%CI] 4.30-7.77, p<0.001; I2=88%). Higher mortality was also observed in patients with FA>5% within 24 hours of admission (OR 7.89; 95%CI 2.63-23.68) and with FA at the initiation of renal replacement therapy (FA>10%, OR 3.87; 95%CI 2.30-6.51; and FA>20%, OR 3.28; 95%CI 2.37-4.55).

Conclusão

While definitions of FA vary widely, its occurrence is associated with increased mortality and worse clinical outcomes.