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Implications of different fluid overload definitions in pediatric stem cell transplant patients requiring continuous renal replacement therapy

Published on Apr 1, 2012in Intensive Care Medicine18.967
· DOI :10.1007/s00134-012-2503-6
Rebecca M. Lombel6
Estimated H-index: 6
(UM: University of Michigan),
Mallika Kommareddi11
Estimated H-index: 11
(UM: University of Michigan)
+ 5 AuthorsMichael Heung23
Estimated H-index: 23
(UM: University of Michigan)
Abstract
Purpose In critically ill pediatric patients, fluid overload (FO) >10% has been identified as a threshold for possible interventions, including initiation of continuous renal replacement therapy (CRRT). However, multiple definitions have been reported, and there remains no consensus method for FO calculation. The goal of this study was to compare different methods of FO determination and to assess their relative value in predicting outcomes.
  • References (26)
  • Citations (18)
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References26
Newest
#1M. Antonelli (UCSC: Catholic University of the Sacred Heart)H-Index: 97
#2Marc J. M. Bonten (UU: Utrecht University)H-Index: 73
Last. Haibo Zhang (U of T: University of Toronto)H-Index: 7
view all 18 authors...
Year in review in Intensive Care Medicine 2011 : I. Nephrology, epidemiology, nutrition and therapeutics, neurology, ethical and legal issues, experimentals
59 CitationsSource
#1David T. Selewski (UM: University of Michigan)H-Index: 22
#2Timothy T. Cornell (UM: University of Michigan)H-Index: 20
Last. Michael Heung (UM: University of Michigan)H-Index: 23
view all 10 authors...
Purpose In pediatric intensive care unit (PICU) patients, fluid overload (FO) at initiation of continuous renal replacement therapy (CRRT) has been reported to be an independent risk factor for mortality. Previous studies have calculated FO based on daily fluid balance during ICU admission, which is labor intensive and error prone. We hypothesized that a weight-based definition of FO at CRRT initiation would correlate with the fluid balance method and prove predictive of outcome.
87 CitationsSource
#2Deborah P. Jones (UTHSC: University of Tennessee Health Science Center)H-Index: 24
Last. Robert F. Tamburro (PSU: Pennsylvania State University)H-Index: 20
view all 9 authors...
Objectives:To assess the long-term benefits of continuous renal replacement therapy (CRRT) in this patient population and to analyze factors associated with survival. Hematopoietic stem cell transplantation is being utilized as curative therapy for a variety of disorders. However, organ dysfunction
22 CitationsSource
#1Scott M. Sutherland (Stanford University)H-Index: 18
#2Michael Zappitelli (MUHC: McGill University Health Centre)H-Index: 33
Last. Stuart L. Goldstein (BCM: Baylor College of Medicine)H-Index: 54
view all 19 authors...
353 CitationsSource
#1Pedro Celiny Ramos Garcia (PUCRS: Pontifícia Universidade Católica do Rio Grande do Sul)H-Index: 19
Last. Robert C. Tasker (University of Cambridge)H-Index: 39
view all 8 authors...
Objective External validation of the paediatric logistic organ dysfunction (PELOD) score in two paediatric intensive care units (PICU) in South America.
20 CitationsSource
#1Leslie W. Hayes (UAB: University of Alabama at Birmingham)H-Index: 5
#2Robert A. Oster (UAB: University of Alabama at Birmingham)H-Index: 27
Last. Ashita Tolwani (UAB: University of Alabama at Birmingham)H-Index: 28
view all 4 authors...
Abstract Purpose Acute kidney injury in the pediatric intensive care unit (PICU) is associated with significant morbidity, with continued mortality greater than 50%. Previous studies have described an association between percentage of fluid overload (%FO) less than 20% and improved survival. We reviewed our continuous renal replacement therapy (CRRT) experience to evaluate for factors associated with mortality as well as secondary outcomes. Materials and Methods This is a retrospective chart rev...
128 CitationsSource
#1Josée Bouchard (UCSD: University of California, San Diego)H-Index: 22
#2Sharon Soroko (UCSD: University of California, San Diego)H-Index: 16
Last. Ravindra L. Mehta (UCSD: University of California, San Diego)H-Index: 64
view all 7 authors...
Fluid accumulation is associated with adverse outcomes in critically ill patients. Here, we sought to determine if fluid accumulation is associated with mortality and non-recovery of kidney function in critically ill adults with acute kidney injury. Fluid overload was defined as more than a 10% increase in body weight relative to baseline, measured in 618 patients enrolled in a prospective multicenter observational study. Patients with fluid overload experienced significantly higher mortality wi...
566 CitationsSource
#1Joe Brierley (The American College of Financial Services)H-Index: 3
#2Joseph A. Carcillo (The American College of Financial Services)H-Index: 51
Last. Aaron L. Zuckerberg (The American College of Financial Services)H-Index: 3
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Background:The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote “best practices” and to improve patient outcomes.Objective:2007 update of the 2002 American College of Critical Care Medicine Clinical Guidelines for Hemodynamic Support of Neonates and C
692 CitationsSource
#1M. Antonelli (UCSC: Catholic University of the Sacred Heart)H-Index: 97
#2Elie AzoulayH-Index: 7
Last. H.-M. Zhang (U of T: University of Toronto)H-Index: 46
view all 19 authors...
Year in review in Intensive Care Medicine, 2008 : I. Brain injury and neurology, renal failure and endocrinology, metabolism and nutrition, sepsis, infections and pneumonia
9 CitationsSource
#1Francisco X. Flores (USF: University of South Florida)H-Index: 9
#2Patrick D. Brophy (Boston Children's Hospital)H-Index: 36
Last. Stuart L. Goldstein (BCM: Baylor College of Medicine)H-Index: 54
view all 16 authors...
Pediatric stem cell transplant (SCT) recipients commonly develop acute renal failure (ARF). We report the demographic and survival data of pediatric SCT patients enrolled in the Prospective Pediatric Continuous Renal Replacement Therapy (ppCRRT) Registry. Since 1 January 2001, 51/370 (13.8%) patients entered in the ppCRRT Registry had received a SCT. Median age was 13.63 (0.53–23.52) years. The primary reasons for the initiation of continuous renal replacement therapy (CRRT) were treatment of fl...
76 CitationsSource
Cited By18
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#1Priti Tewari (University of Texas MD Anderson Cancer Center)H-Index: 6
#2Rajinder P.S. Bajwa (Nationwide Children's Hospital)H-Index: 10
Last. Kris Michael Mahadeo (University of Texas MD Anderson Cancer Center)H-Index: 5
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Hematopoietic cell transplantation (HCT) and cellular therapy (CT) are potentially lifesaving treatments for children with malignant and nonmalignant diseases. Advancements in care have led to expanding patient eligibility, with overall reduced morbidity and improved survival. Survival for HCT patients requiring pediatric intensive care unit (PICU) admission have improved. While almost half of pediatric patients receiving CAR-T therapy may require intensive care support, overall survival remains...
Source
#1Rupesh Raina (Boston Children's Hospital)H-Index: 26
#2Sidharth Kumar Sethi (Medanta)H-Index: 12
Last. Shyam Bansal (Medanta)H-Index: 4
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Abstract Background: A common practice in the management of critically ill patients is fluid resuscitation. An excessive administration of fluids can lead to an imbalance in fluid homeostasis and cause fluid overload (FO). In pediatric critical care patients, FO can lead to a multitude of adverse effects and increased risk of morbidity. Objectives: To review the literature highlighting impact of FO on a multitude of outcomes in critically-ill children, causative versus associative relationship o...
1 CitationsSource
#1Rashid Alobaidi (Boston Children's Hospital)H-Index: 3
#2Catherine Morgan (U of A: University of Alberta)H-Index: 14
Last. Sean M. Bagshaw (U of A: University of Alberta)H-Index: 61
view all 7 authors...
Importance After initial resuscitation, critically ill children may accumulate fluid and develop fluid overload. Accruing evidence suggests that fluid overload contributes to greater complexity of care and worse outcomes. Objective To describe the methods to measure fluid balance, define fluid overload, and evaluate the association between fluid balance and outcomes in critically ill children. Data Sources Systematic search of MEDLINE, EMBASE, Cochrane Library, trial registries, and selected gra...
28 CitationsSource
#1David T. Selewski (UM: University of Michigan)H-Index: 22
#2Stuart L. Goldstein (UC: University of Cincinnati)H-Index: 4
Our understanding of the epidemiology and the impact of acute kidney injury (AKI) and fluid overload on outcomes has improved significantly over the past several decades. Fluid overload occurs commonly in critically ill children with and without associated AKI. Researchers in pediatric AKI have been at the forefront of describing the impact of fluid overload on outcomes in a variety of populations. A full understanding of this topic is important as fluid overload represents a potentially modifia...
9 CitationsSource
#1Cassandra J. Ostroski (UPenn: University of Pennsylvania)H-Index: 1
#2Kenneth J. Drobatz (UPenn: University of Pennsylvania)H-Index: 30
Last. Erica L. Reineke (UPenn: University of Pennsylvania)H-Index: 7
view all 3 authors...
To describe patient characteristics, treatment, and outcome in male cats with urethral obstruction (UO) and fluid overload (FO), and to determine risk factors for the development of FO.Retrospective case-control study from 2002-2012.Eleven client-owned cats with UO that developed respiratory distress secondary to suspected FO and 51 control cats with UO without FO.None.Medical records of cats with UO and FO were identified. FO was defined as the development of respiratory distress secondary to p...
2 CitationsSource
#1Courtney M. Rowan (IU: Indiana University)H-Index: 6
#2Mara Nitu (IU: Indiana University)H-Index: 8
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Background Respiratory failure in the pediatric hematopoietic cell transplant (HCT) recipient is the leading cause for admission to the intensive care unit and carries a high mortality rate. The objective of this study is to investigate the association of clinical risk factors with the development of respiratory failure in the pediatric allogeneic HCT recipient. Procedures This is a single-center, retrospective review of allogeneic pediatric HCT from 2008 to 2014. Multiple variables were examine...
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Background:Fluid therapy is a mainstay during the resuscitation of critically ill children. After initial stabilization, excessive fluid accumulation may lead to complications of fluid overload, which has been independently associated with increased risk for mortality and major morbidity in critically ill children.Objectives:Perform an evidence synthesis to describe the methods used to measure fluid balance, define fluid overload, and evaluate the association between fluid balance and outcomes i...
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#1Stefano Romagnoli (Health Science University)H-Index: 14
#2Alessandra Rizza (Boston Children's Hospital)H-Index: 4
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PERIOPERATIVE FLUID MANAGEMENT has been studied extensively, especially in noncardiac surgery populations, and hypovolemia and hypervolemia clearly have been identified as major contributors of morbidity and mortality. It has been demonstrated that both hypovolemia, eventually leading to inadequate oxygen delivery (DO2), and hypervolemia, which causes tissue edema, organ dysfunction, and coagulation system alterations, are associated with increased perioperative morbidity risk that has been well...
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#1Jiao Chen (Soochow University (Suzhou))H-Index: 1
#2Xiaozhong Li (Soochow University (Suzhou))H-Index: 4
Last. Yanhong Li (Soochow University (Suzhou))H-Index: 10
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Objective To evaluate whether early and acquired daily fluid overload (FO), as well as fluctuations in fluid accumulation, were associated with adverse outcomes in critically ill children with severe sepsis. Methods This study enrolled 202 children in a pediatric intensive care unit (PICU) with severe sepsis. Early fluid overload was defined as ≥5% fluid accumulation occurring in the first 24 hours of PICU admission. The maximum daily fluid accumulation ≥5% occurring during the next 6 days in pa...
15 CitationsSource
#1Matthew D. McGuire (UM: University of Michigan)H-Index: 1
#2Michael Heung (UM: University of Michigan)H-Index: 1
Intravenous fluid resuscitation is ubiquitous throughout medicine and is often considered a benign procedure. Yet, there is now clear recognition of the potential harms of fluid overload after initial resuscitation. In recent years, there has also been an increasing focus on comparing various resuscitation fluids with respect to both benefits and risks. Studies have examined colloids, such as albumin and starches, against the clinical standard of crystalloids. In addition, evidence has emerged t...
6 CitationsSource