• Jose C Flores-González, Cristina Montero Valladares, Cristina Yun Castilla, Juan Mayordomo-Colunga, Sonia Pérez Quesada, Carmen María Martín Delgado, Concha Goñi-Orayen, Francisco Fernández Carrión, Alicia Miras Veiga, Marta Olmedilla-Jodar, Andrés J Alcaraz Romero, Miren Eizmendi-Bereciartua, Carmen Santiago Gutierrez, Esther Aleo Luján, Álvaro Navarro-Mingorance, Iolanda Jordán, and Bronquiolitis en la Unidad de Cuidados Intensivos Pediátricos (BRUCIP) WorkGroup.
• Paediatric Intensive Care Unit, University Hospital Puerta del Mar, Institut INIBICA, Cádiz, Spain.
• Pediatr Crit Care Me. 2019 Mar 1; 20 (3): e130-e136.

ObjectivesIncreasing evidence supports the association of fluid overload with adverse outcomes in different diseases. To our knowledge, few studies have examined the impact of fluid balance on clinical outcome in severe bronchiolitis. Our aim was to determine whether fluid overload was associated with adverse clinical outcomes in critically ill children with severe bronchiolitis.DesignDescriptive, prospective, multicenter study.SettingSixteen Spanish PICUs.PatientsSevere acute bronchiolitis who required admission from October 2014 to May 2015 were included.InterventionsNone.Measurements And Main ResultsTotal fluid intake and output were prospectively recorded during PICU assistance. Fluid balance was measured at 24, 48, and 72 hours after PICU admission. A total of 262 patients were enrolled; 54.6% were male. Median age was 1 month (interquartile range, 1-3 mo). Patients had a positive fluid balance during the first 4 days of PICU admission, reaching a neutral balance on day 4. A positive balance at 24 hours in patients admitted to the PICU with severe bronchiolitis was related with longer stay in PICU (p < 0.001), longer hospital stay (p < 0.001), longer duration of mechanical ventilation (p = 0.016), and longer duration of noninvasive ventilation (p = 0.0029).ConclusionsCritically ill patients with severe acute bronchiolitis who present a positive balance in the first 24 hours of PICU admission have poorer clinical outcomes with longer PICU and hospital length of stay and duration of invasive and noninvasive mechanical ventilation.

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