Fluid Overload and Kidney Injury Score as a Predictor for Ventilator-Associated Events
Objective: The Pediatric and Neonatal Working group developed new ventilator associated events (VAE) definitions for children and neonates. VAE includes ventilator-associated condition (VAC), infection-related ventilator-associated complication (IVAC), and ventilator-associated pneumonia (VAP). Acut...
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Frontiers Media S.A.
2019-05-01
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Series: | Frontiers in Pediatrics |
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Online Access: | https://www.frontiersin.org/article/10.3389/fped.2019.00204/full |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jarin Vaewpanich Jarin Vaewpanich Jarin Vaewpanich Ayse Akcan-Arikan Ayse Akcan-Arikan Ayse Akcan-Arikan Jorge A. Coss-Bu Jorge A. Coss-Bu Curtis E. Kennedy Curtis E. Kennedy Jeffrey R. Starke Jeffrey R. Starke Satid Thammasitboon Satid Thammasitboon |
spellingShingle |
Jarin Vaewpanich Jarin Vaewpanich Jarin Vaewpanich Ayse Akcan-Arikan Ayse Akcan-Arikan Ayse Akcan-Arikan Jorge A. Coss-Bu Jorge A. Coss-Bu Curtis E. Kennedy Curtis E. Kennedy Jeffrey R. Starke Jeffrey R. Starke Satid Thammasitboon Satid Thammasitboon Fluid Overload and Kidney Injury Score as a Predictor for Ventilator-Associated Events Frontiers in Pediatrics ventilator associated pneumonia ventilator-associated condition infection-related ventilator-associated complications FOKIS organ cross-talk |
author_facet |
Jarin Vaewpanich Jarin Vaewpanich Jarin Vaewpanich Ayse Akcan-Arikan Ayse Akcan-Arikan Ayse Akcan-Arikan Jorge A. Coss-Bu Jorge A. Coss-Bu Curtis E. Kennedy Curtis E. Kennedy Jeffrey R. Starke Jeffrey R. Starke Satid Thammasitboon Satid Thammasitboon |
author_sort |
Jarin Vaewpanich |
title |
Fluid Overload and Kidney Injury Score as a Predictor for Ventilator-Associated Events |
title_short |
Fluid Overload and Kidney Injury Score as a Predictor for Ventilator-Associated Events |
title_full |
Fluid Overload and Kidney Injury Score as a Predictor for Ventilator-Associated Events |
title_fullStr |
Fluid Overload and Kidney Injury Score as a Predictor for Ventilator-Associated Events |
title_full_unstemmed |
Fluid Overload and Kidney Injury Score as a Predictor for Ventilator-Associated Events |
title_sort |
fluid overload and kidney injury score as a predictor for ventilator-associated events |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Pediatrics |
issn |
2296-2360 |
publishDate |
2019-05-01 |
description |
Objective: The Pediatric and Neonatal Working group developed new ventilator associated events (VAE) definitions for children and neonates. VAE includes ventilator-associated condition (VAC), infection-related ventilator-associated complication (IVAC), and ventilator-associated pneumonia (VAP). Acute kidney injury (AKI) and fluid overload (FO) have been associated with worse clinical outcomes of ventilated children. Fluid Overload and Kidney Injury Score (FOKIS) is an automatically calculated score that combines AKI and FO in one numeric quantifiable metric. This study analyzed the association between FOKIS and VAE.Design: Retrospective matched case control study.Setting: A freestanding children's hospital.Patients: A total of 168 who were ventilated > 2 days.Interventions: None.Measurements and Main Results: We identified 42 VAC cases (18 IVAC and 24 non-infection-related VAC cases). Controls were matched to cases for age, immunocompromised status and ventilator days prior to VAC. VAC cases had longer ICU days, median (IQR), 28.5 (15, 47) vs. controls 11 (6, 16), p < 0.001; longer ventilation days, 19.5 (13, 32) vs. 9 (4,13), p < 0.001; and higher hospital mortality, 45.2 vs. 18%, p < 0.001. VACs had a higher incidence of AKI, 85.7 vs. 47.3%, p < 0.001; higher peak daily FO% within 3 days preceding VAC, mean (SD), 8.1(7.8) vs. 4.1 (3.4), p < 0.005; and higher peak FOKIS, 6.4(3.8) vs. 3.7(2.8), (p < 0.001). Multivariate regression model adjusted for severity of illness identified peak FOKIS (odds ratio [OR] 1.29, 95%CI: 1.14–1.48, p < 0.001) and peak inspiratory pressure (OR 1.08, 95%CI: 1.02–1.15, p = 0.007) as risk factors for VAC.Conclusions: The FOKIS and its clinical variables were associated risk factors for ventilator-associated events. Further studies will determine the utility of FOKIS as a predictor for VAEs. |
topic |
ventilator associated pneumonia ventilator-associated condition infection-related ventilator-associated complications FOKIS organ cross-talk |
url |
https://www.frontiersin.org/article/10.3389/fped.2019.00204/full |
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doaj-ae4f1038b33c4b94a707af873a0b863b2020-11-25T02:41:34ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602019-05-01710.3389/fped.2019.00204452483Fluid Overload and Kidney Injury Score as a Predictor for Ventilator-Associated EventsJarin Vaewpanich0Jarin Vaewpanich1Jarin Vaewpanich2Ayse Akcan-Arikan3Ayse Akcan-Arikan4Ayse Akcan-Arikan5Jorge A. Coss-Bu6Jorge A. Coss-Bu7Curtis E. Kennedy8Curtis E. Kennedy9Jeffrey R. Starke10Jeffrey R. Starke11Satid Thammasitboon12Satid Thammasitboon13Division of Pediatric Critical Care Medicine, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandSection of Critical Care Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United StatesDepartment of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United StatesSection of Critical Care Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United StatesDepartment of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United StatesSection of Nephrology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United StatesSection of Critical Care Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United StatesDepartment of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United StatesSection of Critical Care Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United StatesDepartment of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United StatesDepartment of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United StatesSection of Infectious Disease Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United StatesSection of Critical Care Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United StatesDepartment of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United StatesObjective: The Pediatric and Neonatal Working group developed new ventilator associated events (VAE) definitions for children and neonates. VAE includes ventilator-associated condition (VAC), infection-related ventilator-associated complication (IVAC), and ventilator-associated pneumonia (VAP). Acute kidney injury (AKI) and fluid overload (FO) have been associated with worse clinical outcomes of ventilated children. Fluid Overload and Kidney Injury Score (FOKIS) is an automatically calculated score that combines AKI and FO in one numeric quantifiable metric. This study analyzed the association between FOKIS and VAE.Design: Retrospective matched case control study.Setting: A freestanding children's hospital.Patients: A total of 168 who were ventilated > 2 days.Interventions: None.Measurements and Main Results: We identified 42 VAC cases (18 IVAC and 24 non-infection-related VAC cases). Controls were matched to cases for age, immunocompromised status and ventilator days prior to VAC. VAC cases had longer ICU days, median (IQR), 28.5 (15, 47) vs. controls 11 (6, 16), p < 0.001; longer ventilation days, 19.5 (13, 32) vs. 9 (4,13), p < 0.001; and higher hospital mortality, 45.2 vs. 18%, p < 0.001. VACs had a higher incidence of AKI, 85.7 vs. 47.3%, p < 0.001; higher peak daily FO% within 3 days preceding VAC, mean (SD), 8.1(7.8) vs. 4.1 (3.4), p < 0.005; and higher peak FOKIS, 6.4(3.8) vs. 3.7(2.8), (p < 0.001). Multivariate regression model adjusted for severity of illness identified peak FOKIS (odds ratio [OR] 1.29, 95%CI: 1.14–1.48, p < 0.001) and peak inspiratory pressure (OR 1.08, 95%CI: 1.02–1.15, p = 0.007) as risk factors for VAC.Conclusions: The FOKIS and its clinical variables were associated risk factors for ventilator-associated events. Further studies will determine the utility of FOKIS as a predictor for VAEs.https://www.frontiersin.org/article/10.3389/fped.2019.00204/fullventilator associated pneumoniaventilator-associated conditioninfection-related ventilator-associated complicationsFOKISorgan cross-talk |