The influence of fluid overload on the length of mechanical ventilation in infants undergoing pediatric congenital heart surgery

doi:10.3969/j.issn.1672-5301.2017.03.007

Abstract：Objective The objectives of this study were to describe the association between fluid overload (FO)and length of mechanical ventilation (LMV),oxygen requirement and radiological findings of pulmonary and chest wall edema. Methods This study was a retrospective and two centers (ICUs,the fifth people′s Hospital of Shangrao city and Wuhan Asia Heart Hospital)chart review of infants who underwent congenital heart surgery be-tween June 2014 and June 2016,87 infants who aged less than 6 months were included. Univariate and multivariate associations between maximum cumulative fluid balance and LMV and oxygenation index(OI)were tested using the Spearman correlation test and multiple linear regression models,respectively. Results Maximum cumulative fluid overload was associated with LMV (adjusted analysis beta coefficient=0.289,95%CI 1.643-4.928,P<0.01), length of stay in the pediatric intensive care unit (Spearman′s correlation=0.47,P<0.001),and presence of chest wall edema and pleural effusions on chest radiograph (Mann Whitney test,P=0.028 and P=0.012). Amount of red blood cells transfused and use of nitric oxide were independently associated with increased LMV (P al <0.01). Conclusion Fluid overload can cause pleural effusion, decrease oxygenation index, limit respiratory-related physio-logical indexes, prolong the postoperative mechanical ventilation time and ICU residence time of patients with con-genital heart disease; There is no correlation between fluid overload and chest wall edema and secondary cannulae;accumulating observational evidence suggests that cautious use of fluid in the postoperative care may be warranted.