(700) Fluid Overload and Functional Status in Pediatric ARDS Survivors: A Retrospective Cohort Study

Introduction: Fluid overload in pediatric acute respiratory distress syndrome (PARDS) has been associated with worse clinical outcomes. The association between fluid overload and functional status among PARDS survivors remains poorly studied. We hypothesized that fluid overload is associated with worse functional status in these patients.

Methods: This retrospective cohort study included patients with PARDS (2023 PALICC criteria) between Feb2009–Oct2016. The primary outcome was change in functional status, assessed by Functional Status Scale (FSS) at hospital admission and discharge. An overall change of FSS≥3 or ≥1 in any specific domain (mental, sensory, communication, motor, feeding, respiration) indicated a functional deterioration. Intake (IV fluids, parental nutrition, blood, feeds) and output (urine, blood losses, CRRT/ ECMO ultrafiltration) data from the first 14 days of PARDS were recorded. Fluid overload (FO,%) was calculated as (intake–output)/admission weightx100%. Cumulative overload (CFO,%) was the sum of daily FO. FOMV days are days with FO≥10% whilst supported on invasive mechanical ventilation(MV). Peak FO was the highest CFO reached. Rate to peak FO was defined as Peak FO divided by the number of days required to reach the peak.

Results: Among 67 PARDS survivors [median age 2.6(IQR: 0.5,9.7) years], 46(68.7%) had severe PARDS. Baseline and discharge FSS were 6(6,7) and 7(6,10), respectively. Nine(13.4%) patients experienced FSS≥3 deterioration. The feeding domain was most commonly affected (n=17,25.4%), followed by respiration (n=9,13.4%). Deterioration in overall FSS was not associated with FOMV days (p=.30), peak FO (p=.10), rate to peak FO (p=.38) or day of peak FO (p=.08). Deterioration in the feeding domain was associated with FOMV days (OR1.22, 95%CI 1.04-1.43, p=.01) and peak FO (OR1.06, 95%CI 1.01-1.12, p=.03), after adjusting for PARDS severity. Deterioration in the mental, sensory, communication, motor, and respiration domains was not associated with fluid overload.

Conclusions: In this study, FOMV days and peak FO was associated with deterioration in the feeding domain. However, fluid overload was not associated with overall deterioration in FSS. This may suggest that fluid overload has limited impact on functional outcomes, with the greatest effect seen in the feeding function.