■流体通常用于各种目的,比如复苏,replacement,维护,营养,或药物输注。然而,它的使用并非没有风险。危重患者极易发生液体积聚(FA),这与糟糕的结果有关,包括器官功能障碍,长时间机械通气,延长住院时间,和死亡率增加。本研究旨在评估危重患儿的FA与不良预后之间的关系。
■在本系统综述和荟萃分析中,我们搜索了PubMed,Embase,ClinicalTrials.gov,和Cochrane图书馆数据库从成立到2024年5月。使用以下术语搜索相关出版物:儿童,孩子们,婴儿,婴儿,儿科,儿科,危重病儿童,病危,重症监护,重症监护,儿科重症监护,儿科重症监护室,流体平衡,流体过载,流体积聚,液体疗法,水肿,呼吸衰竭,呼吸功能不全,肺水肿,机械通气,血流动力学不稳定,震惊,脓毒症,急性肾功能衰竭,急性肾衰竭,急性肾损伤,肾脏替代疗法,透析,死亡率。如果儿科研究评估FA对感兴趣的结果的影响,则认为它们是合格的。主要结果是全因死亡率。通过使用随机效应模型进行汇集分析。这篇评论在PROSPERO(CRD42023432879)上注册。
■共纳入120项研究(44,682名儿童)。确定了35个FA定义。总的来说,FA与死亡率增加显著相关(比值比[OR]4.36;95%置信区间[CI]3.53-5.38),急性肾损伤(OR1.98;95%CI1.60-2.44),长时间机械通气(加权平均差[WMD]38.1h,95%CI19.35-56.84),在重症监护病房的停留时间更长(WMD2.29天;95%CI1.19-3.38)。与非幸存者相比,幸存者的FA百分比较低(WMD-4.95[95%CI,-6.03至-3.87])。当仅考虑控制潜在混杂变量的研究时,汇总分析显示,与FA百分比每增加1%相关的死亡率增加6%(校正后OR=1.06[95%CI,1.04~1.09).
■FA与危重患儿预后较差显著相关。因此,临床医生应密切监测液体平衡,尤其是当水肿患者出现新发作或恶化的器官功能障碍时,提示潜在的FA综合征。未来的研究应该探索限制性液体治疗或复苏方法等干预措施。同时,在获得进一步证据之前,应优先采取预防措施以减轻FA.
■无。
UNASSIGNED: Fluids are often administered for various purposes, such as resuscitation, replacement, maintenance, nutrition, or drug infusion. However, its use is not without risks. Critically ill patients are highly susceptible to fluid accumulation (FA), which is associated with poor outcomes, including organ dysfunction, prolonged mechanical ventilation, extended hospital stays, and increased mortality. This study aimed to assess the association between FA and poor outcomes in critically ill children.
UNASSIGNED: In this systematic review and meta-analysis, we searched PubMed, Embase, ClinicalTrials.gov, and Cochrane Library databases from inception to May 2024. Relevant publications were searched using the following terms: child, children, infant, infants, pediatric, pediatrics, critically ill children, critical illness, critical care, intensive care, pediatric intensive care, pediatric intensive care unit, fluid balance, fluid overload, fluid accumulation, fluid therapy, edema, respiratory failure, respiratory insufficiency, pulmonary edema, mechanical ventilation, hemodynamic instability, shock, sepsis, acute renal failure, acute kidney failure, acute kidney injury, renal replacement therapy, dialysis, mortality. Paediatric studies were considered eligible if they assessed the effect of FA on the outcomes of interest. The main outcome was all-cause mortality. Pooled analyses were performed by using random-effects models. This review was registered on PROSPERO (CRD42023432879).
UNASSIGNED: A total of 120 studies (44,682 children) were included. Thirty-five FA definitions were identified. In general, FA was significantly associated with increased mortality (odds ratio [OR] 4.36; 95% confidence interval [CI] 3.53-5.38), acute kidney injury (OR 1.98; 95% CI 1.60-2.44), prolonged mechanical ventilation (weighted mean difference [WMD] 38.1 h, 95% CI 19.35-56.84), and longer stay in the intensive care unit (WMD 2.29 days; 95% CI 1.19-3.38). The percentage of FA was lower in survivors when compared to non-survivors (WMD -4.95 [95% CI, -6.03 to -3.87]). When considering only studies that controlled for potential confounding variables, the pooled analysis revealed 6% increased odds of mortality associated with each 1% increase in the percentage of FA (adjusted OR = 1.06 [95% CI, 1.04-1.09).
UNASSIGNED: FA is significantly associated with poorer outcomes in critically ill children. Thus, clinicians should closely monitor fluid balance, especially when new-onset or worsening organ dysfunction occurs in oedematous patients, indicating potential FA syndrome. Future research should explore interventions like restrictive fluid therapy or de-resuscitation methods. Meanwhile, preventive measures should be prioritized to mitigate FA until further evidence is available.
UNASSIGNED: None.