{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T17:01:18Z","timestamp":1785862878232,"version":"3.56.0"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,10,14]],"date-time":"2021-10-14T00:00:00Z","timestamp":1634169600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess the association of cumulative fluid overload (FO) up to 14 days from the diagnosis of pediatric acute respiratory syndrome (PARDS) with pediatric intensive care unit (PICU) mortality, 28\u2010day mechanical ventilation free days (VFD), and 28\u2010day intensive care unit free days (IFD). We hypothesized that fluid overload, even beyond the acute period, would be associated with increased morbidity and mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study of PARDS patients admitted to PICU from 2009 to 2015. For repeated admissions, we considered the admission with the highest oxygenation index (OI). Daily FO (%) was calculated as (intake\u2009\u2212\u2009output)\/weight at PICU admission\u2009\u00d7\u2009100. Peak cumulative FO (CFO) was the highest CFO from the diagnosis of PARDS to Day 14 or to PICU discharge or mortality, whichever was earliest. Rate to peak CFO was the peak CFO divided by the number of days to reach that highest CFO. The association of FO with mortality, VFD and IFD were analyzed with logistic and linear regression models, with the following covariates: Pediatric Index of Mortality 2 score, PARDS severity, and the presence of acute kidney injury (AKI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 165 patients included in this study, with a mortality rate of 45.5% (75\/165), median age 3.2 years (interquartile range [IQR] 0.7\u20139.9) and OI 15.8 (IQR 9.5\u201327.9). Seventy\u2010three (44.2%) patients had severe PARDS and 64 (38.8%) had AKI. AKI (aOR [adjusted odds ratio] 3.19, 95% CI [confidence interval] 1.43\u20137.09, <jats:italic>p<\/jats:italic>\u2009=\u20090.004) and rate to peak cumulative FO (aOR 1.23, 95% CI 1.07\u20131.42, <jats:italic>p<\/jats:italic>\u2009=\u20090.004) were associated with mortality. AKI and peak cumulative FO were associated with decreased VFD and IFD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The rate to peak CFO over the first 14 days of PARDS was associated with mortality and peak CFO was associated with decreased VFD and IFD.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.25720","type":"journal-article","created":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T12:12:21Z","timestamp":1633954341000},"page":"300-307","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Fluid overload in children with pediatric acute respiratory distress syndrome: A retrospective cohort study"],"prefix":"10.1002","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3504-7656","authenticated-orcid":false,"given":"Esther H.","family":"Leow","sequence":"first","affiliation":[{"name":"Department of Paediatric Nephrology KK Women's and Children's Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith J.\u2010M.","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Pediatric Subspecialties, Children's Intensive Care Unit KK Women's and Children's Hospital  Singapore"},{"name":"Duke\u2010NUS Medical School  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yee H.","family":"Mok","sequence":"additional","affiliation":[{"name":"Department of Pediatric Subspecialties, Children's Intensive Care Unit KK Women's and Children's Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph P.","family":"Hornik","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Duke University School of Medicine Durham North Carolina USA"},{"name":"Duke Clinical Research Institute Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong H.","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Paediatric Nephrology KK Women's and Children's Hospital  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8430-4217","authenticated-orcid":false,"given":"Jan H.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pediatric Subspecialties, Children's Intensive Care Unit KK Women's and Children's Hospital  Singapore"},{"name":"Duke\u2010NUS Medical School  Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,10,14]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001259"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-017-4683-6"},{"issue":"7","key":"e_1_2_7_4_1","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1097\/CCM.0000000000004376","article-title":"Fluid accumulation in 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