Table 1.
Summary of included articles.
| Study | Design | Outcome measure | Variable measure | Subjects | Definition ARDS | Outcome | NOS total |
|---|---|---|---|---|---|---|---|
| Flori et al. (59) | Post hoc analysis of a prospective observational study | PICU mortality, VFDs | Cumulative fluid balance in 10 ml/kg/day increments | 313 children with ALI | ALI according to AECC definition | OR 1.08 (p = 0.02) mortality with increasing cumulative FB, VFDs (p = 0.02) | 8 |
| Valentine et al. (60) | Multicenter, retrospective cohort study | VFDs | Cumulative fluid balance and fluid overload (%) | 168 children meeting ALI criteria | ALI according to AECC definition | Increasing cumulative FB at day 2–4 associated with fewer VFDs (p = 0.01/p = 0.01/p = 0.05). Cumulative fluid balance was not associated with mortality (p = 0.11) | 7 |
| Willson et al. (61) | Post hoc analysis of pediatric arm of prospective, randomized, placebo-controlled trial | In-hospital mortality, duration of MV, PICU, and hospital LoS, VFDs, OSI | Cumulative fluid balance | 110 children with direct ALI/ARDS | ALI/ARDS according to AECC definition | Cumulative FB was associated with mortality (p < 0.001), VFDs (p < 0.001), PICU-free days (p = 0.14), and hospital-free days (p = 0.06). OSI increase of 0.52/l/m2 increase FB (p = 0.011) | 8 |
| Hu et al. (62) | Prospective study in 26 PICUs | Incidence, mortality and burden of AHRF and ARDS | Daily fluid balance | 461 patients with AHRF, of which 306 (66%) ARDS | AHRF: PaO2 ≤50 mmHg or PaO2/FiO2 ≤250 mmHg for ≥6 h, needing FiO2 >30% and PEEP >2 cm H2O to maintain PaO2 >60 mmHg or SpO2 >90%. ALI/ARDS according to AECC definition | In AHRF: non-survivors had higher median FB (p = 0.079). Mortality of FB ≤10 ml/kg/day lower than >10 (p = 0.049). No specific ARDS data | 6 |
| Randolph et al. (63) | Prospective clinical trial | Extubation success (use of ERT) and duration of weaning | Cumulative fluid balance at extubation and start weaning | 301 children with mechanical ventilation >24 h | No mention of ARDS definition | No relation cumulative FB with successful extubation. Duration of weaning with cumulative FB at ERT (HR 0.94, p = 0.06) and at extubation (HR 0.94, p = 0.051). No ARDS data only | 7 |
PICU, pediatric intensive care unit; ALI, acute lung injury; AECC, American-European consensus conference; VFDs, ventilator-free days; MV, mechanical ventilation; LoS, length of stay; OSI, oxygenation saturation index; FB, fluid balance; AHRF, acute hypoxemic respiratory failure; ERT, extubation readiness test.