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

Am J Respir Crit Care Med
Authors
Keywords
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 

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.

Year of Publication
2018
Journal
Am J Respir Crit Care Med
Volume
197
Issue
9
Pages
1128-1135
Date Published
2018 05 01
ISSN
1535-4970
DOI
10.1164/rccm.201709-1860OC
PubMed ID
29313715
PubMed Central ID
PMC6019929
Links
Grant list
U01 AI110397 / AI / NIAID NIH HHS / United States
K23 HL138162 / HL / NHLBI NIH HHS / United States
R01 AI073964 / AI / NIAID NIH HHS / United States
T32 HD040128 / HD / NICHD NIH HHS / United States
K12 HD047349 / HD / NICHD NIH HHS / United States
UL1 TR001102 / TR / NCATS NIH HHS / United States
K24 AI106822 / AI / NIAID NIH HHS / United States