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Fluid Balance Is Associated with Clinical Outcomes and Extravascular Lung Water in Children with Acute Asthma Exacerbation.
Kantor, David B. 1,2; Hirshberg, Eliotte L. 3,4; McDonald, Molly C. 5; Griffin, John 1; Buccigrosso, Tess 5; Stenquist, Nicole 1; Smallwood, Craig D. 1,2; Nelson, Kyle A. 6,7; Zurakowski, David 1,2; Phipatanakul, Wanda 7,8; Hirschhorn, Joel N. 9,10,11
[Article] American Journal of Respiratory & Critical Care Medicine. 197(9):1128-1135, May 1, 2018.

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Rationale: 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.

Objectives: Investigate how fluid balance influences clinical outcomes in children hospitalized for asthma exacerbation.

Methods: We analyzed the association between fluid overload and clinical outcomes in a retrospective cohort of children admitted to an urban children's 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.

Measurements and Main Results: In the retrospective cohort, peak fluid overload [(fluid input - output)/weight] is associated with longer hospital length of stay, longer treatment duration, and increased risk of supplemental oxygen use (P values < 0.001). 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 < 0.001), longer length of stay (P = 0.01), longer treatment duration (P = 0.03), and increased risk of supplemental oxygen use (P = 0.02).

Conclusions: Excess volume administration leading to fluid overload in children with acute asthma exacerbation is associated with increased extravascular lung water and worse clinical outcomes.