1. The Use of Diuretic in Mechanically Ventilated Children with Viral Bronchiolitis: a Cohort Study
- Author
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Nisha Agasthya, James H. Hertzog, Jigar C. Chauhan, and Kimberlee Chromey
- Subjects
medicine.medical_treatment ,Population ,mechanical ventilation ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,furosemide ,education ,Pediatric intensive care unit ,Mechanical ventilation ,education.field_of_study ,business.industry ,RC86-88.9 ,Furosemide ,030208 emergency & critical care medicine ,Retrospective cohort study ,Medical emergencies. Critical care. Intensive care. First aid ,General Medicine ,medicine.disease ,Bronchiolitis ,Anesthesia ,bronchiolitis ,Diuretic ,business ,Cohort study ,medicine.drug ,Research Article - Abstract
Introduction Viral bronchiolitis is a leading cause of admissions to pediatric intensive care unit (PICU). A literature review indicates that there is limited information on fluid overload and the use of diuretics in mechanically ventilated children with viral bronchiolitis. This study was conducted to understand diuretic use concerning fluid overload in this population. Material and methods A retrospective cohort study performed at a quaternary children’s hospital. The study population consisted of mechanically ventilated children with bronchiolitis, with a confirmed viral diagnosis on polymerase chain reaction (PCR) testing. Children with co-morbidities were excluded. Data collected included demographics, fluid status, diuretic use, morbidity and outcomes. The data were compared between groups that received or did not receive diuretics. Result Of the 224 mechanically ventilated children with confirmed bronchiolitis, 179 (79%) received furosemide on Day 2 of invasive ventilation. Out of these, 72% of the patients received intermittent intravenous furosemide, whereas 28% received continuous infusion. It was used more commonly in patients who had a higher fluid overload. Initial fluid overload was associated with longer duration of mechanical ventilation (median days 6 vs 4, p Conclusion Diuretics are frequently used in mechanically ventilated children with bronchiolitis and fluid overload, with intermittent dosing of furosemide being the commonest treatment. There is a potential benefit of improved oxygenation in these children, though further research is needed to quantify this benefit and any potential harm. Due to potential harm with fluid overload, restrictive fluid strategies may have a potential benefit.
- Published
- 2021