{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T14:00:47Z","timestamp":1790517647433,"version":"4.1.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2018,5,1]],"date-time":"2018-05-01T00:00:00Z","timestamp":1525132800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>The effects of fluid administration during acute asthma exacerbation are likely unique in this patient population: highly negative inspiratory intrapleural pressure resulting from increased airway resistance may interact with excess fluid administration to favor the accumulation of extravascular lung water, leading to worse clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Investigate how fluid balance influences clinical outcomes in children hospitalized for asthma exacerbation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed the association between fluid overload and clinical outcomes in a retrospective cohort of children admitted to an urban children\u2019s hospital with acute asthma exacerbation. These findings were validated in two cohorts: a matched retrospective and a prospective observational cohort. Finally, ultrasound imaging was used to identify extravascular lung water and investigate the physiological basis for the inferential findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>In the retrospective cohort, peak fluid overload [(fluid input\u2009\u2212\u2009output)\/weight] is associated with longer hospital length of stay, longer treatment duration, and increased risk of supplemental oxygen use (P values\u2009&amp;lt;\u20090.001). Similar results were obtained in the validation cohorts. There was a strong interaction between fluid balance and intrapleural pressure: the combination of positive fluid balance and highly negative inspiratory intrapleural pressures is associated with signs of increased extravascular lung water (P\u2009&amp;lt;\u20090.001), longer length of stay (P\u2009=\u20090.01), longer treatment duration (P\u2009=\u20090.03), and increased risk of supplemental oxygen use (P\u2009=\u20090.02).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Excess volume administration leading to fluid overload in children with acute asthma exacerbation is associated with increased extravascular lung water and worse clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201709-1860oc","type":"journal-article","created":{"date-parts":[[2018,1,9]],"date-time":"2018-01-09T10:44:02Z","timestamp":1515494642000},"page":"1128-1135","source":"Crossref","is-referenced-by-count":25,"title":["Fluid Balance Is Associated with Clinical Outcomes and Extravascular Lung Water in Children with Acute Asthma Exacerbation"],"prefix":"10.1093","volume":"197","author":[{"given":"David B.","family":"Kantor","sequence":"first","affiliation":[{"name":"Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine"},{"name":"Department of Anaesthesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliotte L.","family":"Hirshberg","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Intermountain Medical Center, Murray, Utah"},{"name":"Department of Pediatrics, Division of Pediatric Critical Care, University of Utah, Salt Lake City, Utah; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly C.","family":"McDonald","sequence":"additional","affiliation":[{"name":"Clinical Research Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Griffin","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tess","family":"Buccigrosso","sequence":"additional","affiliation":[{"name":"Clinical Research Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Stenquist","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig D.","family":"Smallwood","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine"},{"name":"Department of Anaesthesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle A.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine"},{"name":"Department of Pediatrics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Zurakowski","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine"},{"name":"Department of Anaesthesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanda","family":"Phipatanakul","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, and"},{"name":"Division of Allergy and Immunology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel N.","family":"Hirschhorn","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts"},{"name":"Department of Genetics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,5,1]]},"reference":[{"key":"2026032023185767500_bib1","doi-asserted-by":"crossref","first-page":"25S","DOI":"10.1378\/chest.63.4_Supplement.25S","article-title":"Relation between pulmonary arterial pressure and pleural pressure during the acute asthmatic attack","volume":"63","author":"Permutt","year":"1973","journal-title":"Chest"},{"key":"2026032023185767500_bib2","first-page":"1","article-title":"Cardiovascular effects of airways obstruction","volume":"169","author":"Scharf","year":"1991","journal-title":"Hai"},{"key":"2026032023185767500_bib3","first-page":"974","article-title":"Pride NB. 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