Less is more: Fluids in critically ill children with acute respiratory failure

Research output: PhD ThesisPhd-Thesis - Research and graduation internal

Abstract

Fluid overload is a major issue in critically ill patients, describing the accumulation of fluid in the body, resulting in fluid overload leading to edema. It is associated with adverse outcome, such as prolonged duration of mechanical ventilation and higher mortality. This thesis focuses on the pathophysiology, diagnosis and prevention of fluid overload in critically ill children. While in adult patients a lot of research has described fluid overload and its consequences, this is not the case in critically ill children. We aim to assess the effect of different fluid strategies during acute respiratory distress syndrome (ARDS), employing different experimental models of ARDS comparing conservative and liberal fluid treatment. We find that a conservative fluid strategy reduces pulmonary edema in adult animals, yet not in infants. This suggests younger animals to be less susceptible to the development of fluid overload. In subsequent clinical studies, we find that even in children with a relatively benign acute respiratory disease, fluid overload accumulates in large amounts as reflected by a strong positive cumulative fluid balance associated with a longer duration of mechanical ventilation. In a similar patient cohort, we perform a randomized-controlled trial wherein children are randomized to different fluid strategies. This seems feasible and safe, yet requires further refinement for future investigations. Lastly, we use lung ultrasound to assess pulmonary congestion, yet did not detect an increase in pulmonary edema in relation to increased amounts of fluid overload in children with acute viral respiratory tract infection on mechanical ventilation.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
Supervisors/Advisors
  • van Woensel, Jacobus, Supervisor
  • Bem, Reinout, Co-supervisor
  • Lemson, J., Co-supervisor, External person
Award date13 Dec 2019
Print ISBNs9789463613378
Publication statusPublished - 2019

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