This preprint is under consideration at Critical Care. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Matthew Barhight
Ann and Robert H Lurie Children's Hospital of Chicago
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1954-5823
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Hyperchloremia and the administration of higher chloride loads have been associated with worse clinical outcomes in critically ill patients. We sought to evaluate the electrolyte profile and clinical outcomes associated with a unit-wide transition from saline to balanced fluids as standard care for resuscitation and maintenance fluid administration in a pediatric intensive care unit (PICU).
Methods: A before and after analysis of patients admitted to a PICU in a large, urban, academic hospital between May 2018 and March 2020. The transition from the use of saline as the main fluid of choice to the use of balanced fluids for both resuscitation and maintenance fluid as standard care occurred in June 2019. The primary outcome was acute kidney injury (AKI) and the secondary outcomes were mortality, ventilator free days (VFD), need for renal replacement therapy (RRT), hospital length of stay (LOS), and electrolyte abnormalities.
Results: Overall, 2863 patients (47% female) with an AKI rate of 8% (n=228) and a mortality rate of 2.8% (n=79) were included. The pre-intervention period (May 2018 to April 2019) included 1,380 patients and the post-intervention period (August 2019 to March 2020) included 1,483 patients. After adjusting for confounders (age, PRISM III, mechanical ventilation and immunocompromised state), there were no significant differences in the odds of AKI (Pre 8.1%, Post 8%; adjusted odds ratio [aOR] 1.0 95%CI 0.8-1.3, p=0.98). Additionally, there were no differences in the odds of mortality, VFD, need for RRT, nor hospital LOS. The post-intervention period had fewer patients with hyperchloremia (Pre 10.4% vs. Post 15.5%, p=<0.0001) and hyperkalemia (Pre 1.4% vs. Post 3.2%, p=0.02) and more patients with hypochloremia (Pre 9.5% vs. Post 14.4%, p=<0.0001) and hypokalemia (Pre 38.2% vs. Post 47.2%, p=<0.0001).
Conclusions: Following a unit-wide implementation of balanced fluids as standard care, there were no differences in rates of AKI or other clinical outcomes. However, there were changes in the electrolyte profile: lower rates of hyperkalemia and hyperchloremia and higher rates of hypokalemia and hypochloremia. Further evaluation of the effect of balanced fluids and the clinical significance of electrolyte abnormalities in critically ill children is needed.
Keywords
balanced fluids, acute kidney injury, mortality, pediatric critical care
Loading...
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 25 Mar, 2021
No community comments so far
Review #2 received
Received 04 Apr, 2021
Review #1 received
Received 04 Apr, 2021
Review #? received
Received 03 Apr, 2021
Reviewer #3 agreed
On 03 Apr, 2021
Reviewer #2 agreed
On 31 Mar, 2021
Reviewers invited
Invitations sent on 31 Mar, 2021
Reviewer #1 agreed
On 31 Mar, 2021
Editor invited
On 24 Mar, 2021
Submission checks complete
On 24 Mar, 2021
Editor assigned
On 23 Mar, 2021
First submitted
On 23 Mar, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
Learn more about our company.
This preprint is under consideration at Critical Care. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Matthew Barhight
Ann and Robert H Lurie Children's Hospital of Chicago
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1954-5823
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 25 Mar, 2021
No community comments so far
Review #2 received
Received 04 Apr, 2021
Review #1 received
Received 04 Apr, 2021
Review #? received
Received 03 Apr, 2021
Reviewer #3 agreed
On 03 Apr, 2021
Reviewer #2 agreed
On 31 Mar, 2021
Reviewers invited
Invitations sent on 31 Mar, 2021
Reviewer #1 agreed
On 31 Mar, 2021
Editor invited
On 24 Mar, 2021
Submission checks complete
On 24 Mar, 2021
Editor assigned
On 23 Mar, 2021
First submitted
On 23 Mar, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Hyperchloremia and the administration of higher chloride loads have been associated with worse clinical outcomes in critically ill patients. We sought to evaluate the electrolyte profile and clinical outcomes associated with a unit-wide transition from saline to balanced fluids as standard care for resuscitation and maintenance fluid administration in a pediatric intensive care unit (PICU).
Methods: A before and after analysis of patients admitted to a PICU in a large, urban, academic hospital between May 2018 and March 2020. The transition from the use of saline as the main fluid of choice to the use of balanced fluids for both resuscitation and maintenance fluid as standard care occurred in June 2019. The primary outcome was acute kidney injury (AKI) and the secondary outcomes were mortality, ventilator free days (VFD), need for renal replacement therapy (RRT), hospital length of stay (LOS), and electrolyte abnormalities.
Results: Overall, 2863 patients (47% female) with an AKI rate of 8% (n=228) and a mortality rate of 2.8% (n=79) were included. The pre-intervention period (May 2018 to April 2019) included 1,380 patients and the post-intervention period (August 2019 to March 2020) included 1,483 patients. After adjusting for confounders (age, PRISM III, mechanical ventilation and immunocompromised state), there were no significant differences in the odds of AKI (Pre 8.1%, Post 8%; adjusted odds ratio [aOR] 1.0 95%CI 0.8-1.3, p=0.98). Additionally, there were no differences in the odds of mortality, VFD, need for RRT, nor hospital LOS. The post-intervention period had fewer patients with hyperchloremia (Pre 10.4% vs. Post 15.5%, p=<0.0001) and hyperkalemia (Pre 1.4% vs. Post 3.2%, p=0.02) and more patients with hypochloremia (Pre 9.5% vs. Post 14.4%, p=<0.0001) and hypokalemia (Pre 38.2% vs. Post 47.2%, p=<0.0001).
Conclusions: Following a unit-wide implementation of balanced fluids as standard care, there were no differences in rates of AKI or other clinical outcomes. However, there were changes in the electrolyte profile: lower rates of hyperkalemia and hyperchloremia and higher rates of hypokalemia and hypochloremia. Further evaluation of the effect of balanced fluids and the clinical significance of electrolyte abnormalities in critically ill children is needed.
Loading...