{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T02:13:04Z","timestamp":1758161584645,"version":"3.44.0"},"reference-count":52,"publisher":"Mathematical Modelling and Numerical Simulation with Applications","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Pediatr Intensive Care"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Fluid overload has been associated with increased oxygen requirement, prolonged duration of mechanical ventilation, and longer length of hospital stay in children hospitalized with pulmonary diseases. Critically ill infants with bronchiolitis admitted to the pediatric intensive care unit (PICU) also tend to develop fluid overload and there is limited information of its role on noninvasive respiratory support. Thus, our primary objective was to study the association of fluid overload in patients with bronchiolitis admitted to the PICU with respiratory support escalation (RSE) and need for endotracheal intubation (ETI). Infants \u226424 months of age with bronchiolitis and admitted to the PICU between 9\/2009 and 6\/2015 were retrospectively studied. Demographic variables, clinical characteristics including type of respiratory support and need for ETI were evaluated. Fluid overload as assessed by net fluid intake and output (net fluid balance), cumulative fluid balance (CFB) (mL\/kg), and percentage fluid overload (FO%), was compared between patients requiring and not requiring RSE and among patients requiring ETI and not requiring ETI at 0 (PICU admission), 12, 24, 36, 48, 72, 96, and 120\u2009hours. One-hundred sixty four of 283 patients with bronchiolitis admitted to the PICU qualified for our study. Thirty-four of 164 (21%) patients required escalation of respiratory support within 5 days of PICU admission and of these 34 patients, 11 patients required ETI. Univariate analysis by Kruskal-Wallis test of fluid overload as assessed by net fluid balance, CFB, and FO% between 34 patients requiring and 130 patients not requiring RSE and among 11 patients requiring ETI and 153 patients not requiring ETI, at 0, 12, 24, 36, 48, 72, 96 and 120\u2009hours did not reveal any significant difference (p &gt;0.05) at any time interval. Multivariable logistic regression analysis revealed higher PRISM score (odds ratio [OR]: 4.95, 95% confidence interval [95% CI]: 1.79\u201313.66; p\u2009=\u20090.002), longer hours on high flow nasal cannula (OR: 4.86, 95% CI: 1.68\u201314.03; p\u2009=\u20090.003) and longer hours on noninvasive ventilation (OR: 11.16, 95% CI: 3.36\u201336.98; p\u2009&lt;\u20090.001) were associated with RSE. Fluid overload as assessed by net fluid balance, CFB, and FO% was not associated with RSE or need for ETI in critically ill bronchiolitis patients admitted to the PICU. Further prospective studies involving larger number of patients with bronchiolitis are needed to corroborate our findings.<\/jats:p>","DOI":"10.1055\/s-0041-1735873","type":"journal-article","created":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T18:52:19Z","timestamp":1631645539000},"page":"007-017","source":"Crossref","is-referenced-by-count":0,"title":["Association of Fluid Overload with Escalation of Respiratory Support and Endotracheal Intubation in Acute Bronchiolitis Patients"],"prefix":"10.53391","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5629-7788","authenticated-orcid":false,"given":"Orkun","family":"Baloglu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Critical Care Medicine, Cleveland Clinic Children\u0300s, Cleveland, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren K.","family":"Flagg","sequence":"additional","affiliation":[{"name":"Department of Pediatric Critical Care Medicine, Cleveland Clinic Children\u0300s, Cleveland, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Suleiman","sequence":"additional","affiliation":[{"name":"Department of Pediatric Critical Care Medicine, Cleveland Clinic Children\u0300s, Cleveland, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vedant","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Pediatric Critical Care Medicine, Cleveland Clinic Children\u0300s, Cleveland, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie A.","family":"Fast","sequence":"additional","affiliation":[{"name":"Department of Pediatric Critical Care Medicine, Cleveland Clinic Children\u0300s, Cleveland, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Worley","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hemant S.","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Pediatric Critical Care Medicine, Cleveland Clinic Children\u0300s, Cleveland, Ohio, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"31409","published-online":{"date-parts":[[2021,9,14]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1097\/CCM.0000000000002425","article-title":"American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal shock","volume":"45","author":"A L 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Valentine","year":"2012","journal-title":"Crit Care Med"},{"key":"ref5","first-page":"854142","article-title":"Positive fluid balance is associated with higher mortality and prolonged mechanical ventilation in pediatric patients with acute lung injury","volume":"2011","author":"H R Flori","year":"2011","journal-title":"Crit Care Res Pract"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1097\/PCC.0b013e31822882a3","article-title":"Fluid overload is associated with impaired oxygenation and morbidity in critically ill children","volume":"13","author":"A A Arikan","year":"2012","journal-title":"Pediatr Crit Care Med"},{"issue":"07","key":"ref7","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1097\/PCC.0b013e3182917cb5","article-title":"The relationship of fluid administration to outcome in the pediatric calfactant in acute respiratory distress syndrome trial","volume":"14","author":"D F Willson","year":"2013","journal-title":"Pediatr Crit 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Bronquiolitis en la Unidad de Cuidados Intensivos Pediatricos (BRUCIP) study","volume":"20","author":"J C Flores-Gonz\u00e1lez","year":"2019","journal-title":"Pediatr Crit Care Med"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"55","DOI":"10.5935\/0103-507X.20160003","article-title":"Characteristics and progression of children with acute viral bronchiolitis subjected to mechanical ventilation","volume":"28","author":"R Ferlini","year":"2016","journal-title":"Rev Bras Ter Intensiva"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1097\/PCC.0000000000002631","article-title":"Invasive mechanical ventilation for acute viral bronchiolitis: retrospective multicenter cohort study","volume":"22","author":"R B Mitting","year":"2021","journal-title":"Pediatr Crit Care Med"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"e106","DOI":"10.1097\/PCC.0000000000001060","article-title":"Early fluid overload prolongs 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controlled trial","volume":"389","author":"E Kepreotes","year":"2017","journal-title":"Lancet"},{"issue":"02","key":"ref38","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s00134-016-4617-8","article-title":"High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study)","volume":"43","author":"C Mil\u00e9si","year":"2017","journal-title":"Intensive Care Med"},{"issue":"02","key":"ref39","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1002\/ppul.24553","article-title":"A comparison between high-flow nasal cannula and noninvasive ventilation in the management of infants and young children with acute bronchiolitis in the PICU","volume":"55","author":"B Habra","year":"2020","journal-title":"Pediatr Pulmonol"},{"key":"ref40","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/S0140-6736(16)30951-5","article-title":"Viral bronchiolitis","volume":"389","author":"T A Florin","year":"2017","journal-title":"Lancet"},{"issue":"01","key":"ref41","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1080\/17476348.2019.1554439","article-title":"Therapeutic strategies for pediatric bronchiolitis","volume":"13","author":"M Korppi","year":"2019","journal-title":"Expert Rev Respir Med"},{"issue":"01","key":"ref42","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1136\/adc.55.1.17","article-title":"Effect of nasogastric tubes on nasal resistance during infancy","volume":"55","author":"J Stocks","year":"1980","journal-title":"Arch Dis Child"},{"issue":"06","key":"ref43","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1542\/peds.104.6.1389","article-title":"Previously healthy infants may have increased risk of aspiration during respiratory syncytial viral bronchiolitis","volume":"104","author":"V Khoshoo","year":"1999","journal-title":"Pediatrics"},{"issue":"02","key":"ref44","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/S2213-2600(12)70053-X","article-title":"Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: a randomised trial","volume":"1","author":"E Oakley","year":"2013","journal-title":"Lancet Respir Med"},{"key":"ref45","doi-asserted-by":"crossref","first-page":"496","DOI":"10.3389\/fped.2019.00496","article-title":"Less is more - a feasibility study of fluid strategy in critically ill children with acute respiratory tract infection","volume":"7","author":"S A Ingelse","year":"2019","journal-title":"Front Pediatr"},{"issue":"01","key":"ref46","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1056\/NEJMra1413456","article-title":"Viral bronchiolitis in children","volume":"374","author":"H C Meissner","year":"2016","journal-title":"N Engl J Med"},{"issue":"18","key":"ref47","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1056\/NEJM200005043421806","article-title":"The acute respiratory distress syndrome","volume":"342","author":"L B Ware","year":"2000","journal-title":"N Engl J Med"},{"issue":"06","key":"ref48","doi-asserted-by":"crossref","first-page":"1376","DOI":"10.1164\/ajrccm.163.6.2004035","article-title":"Alveolar fluid clearance is impaired in the majority of patients with acute lung injury and the acute respiratory distress syndrome","volume":"163","author":"L B Ware","year":"2001","journal-title":"Am J Respir Crit Care Med"},{"issue":"02","key":"ref49","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1055\/s-0039-3400467","article-title":"The effects of furosemide on oxygenation in mechanically ventilated children with bronchiolitis","volume":"9","author":"M Kulkarni","year":"2020","journal-title":"J Pediatr Intensive 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