Fluid Overload Mechanically Ventilated Days: A Novel Fluid Exposure Measure in Critically Ill Children With Acute Respiratory Failure

We propose a novel metric evaluating the impact an exposure to a large positive fluid balance over time has on clinical outcomes in children with respiratory failure, termed "fluid overload mechanically ventilated"(FOMV) days. We performed a retrospective cohort study of mechanically ventilated children. Using multivariable regression analyses, each FOMV day was associated with a 5% decreased likelihood of having a ventilator-free day (adjusted incidence rate ratio [aIRR], 0.95; 95% CI, 0.95-0.96), a 5% increased likelihood of having an additional day of stay (aIRR, 1.05; 95% CI 1.05-1.06), and a 6% increased relative risk of death (aRR, 1.06; 95% CI, 1.01-1.11). FOMV is a novel exposure measure in children with acute respiratory failure associated with poor outcomes paralleling published data demonstrating dose-dependent exposure to a positive fluid balance is associated with worse outcomes. FOMV is a targetable exposure metric for future use in quality improvement initiatives and research studies that may help to determine the efficacy of interventions.