<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec id="j_jccm-2021-0008_s_006">
<h3>Introduction</h3>
<p>Viral bronchiolitis is a leading cause of admissions to pediatric intensive care unit (PICU). A literature review indicates that there is limited information on fluid overload and the use of diuretics in mechanically ventilated children with viral bronchiolitis. This study was conducted to understand diuretic use concerning fluid overload in this population.</p>
</sec>
<sec id="j_jccm-2021-0008_s_007">
<h3>Material and methods</h3>
<p> A retrospective cohort study performed at a quaternary children’s hospital. The study population consisted of mechanically ventilated children with bronchiolitis, with a confirmed viral diagnosis on polymerase chain reaction (PCR) testing. Children with co-morbidities were excluded. Data collected included demographics, fluid status, diuretic use, morbidity and outcomes. The data were compared between groups that received or did not receive diuretics.</p>
</sec>
<sec id="j_jccm-2021-0008_s_008">
<h3>Result</h3>
<p> Of the 224 mechanically ventilated children with confirmed bronchiolitis, 179 (79%) received furosemide on Day 2 of invasive ventilation. Out of these, 72% of the patients received intermittent intravenous furosemide, whereas 28% received continuous infusion. It was used more commonly in patients who had a higher fluid overload. Initial fluid overload was associated with longer duration of mechanical ventilation (median days 6 vs 4, p&lt;0.001) and length of stay (median days 10 vs 6, p&lt;0.001) even with the use of furosemide. Superimposed bacterial pneumonia was seen in 60% of cases and was associated with a higher per cent fluid overload at 24 hours (9.1 vs 6.3, p = 0.003).</p>
</sec>
<sec id="j_jccm-2021-0008_s_009">
<h3>Conclusion</h3>
<p> Diuretics are frequently used in mechanically ventilated children with bronchiolitis and fluid overload, with intermittent dosing of furosemide being the commonest treatment. There is a potential benefit of improved oxygenation in these children, though further research is needed to quantify this benefit and any potential harm. Due to potential harm with fluid overload, restrictive fluid strategies may have a potential benefit.</p>
</sec>
</abstract>

Introduction
Viral bronchiolitis is a leading cause of admissions to pediatric intensive care unit (PICU). A literature review indicates that there is limited information on fluid overload and the use of diuretics in mechanically ventilated children with viral bronchiolitis. This study was conducted to understand diuretic use concerning fluid overload in this population.


Material and methods
 A retrospective cohort study performed at a quaternary children’s hospital. The study population consisted of mechanically ventilated children with bronchiolitis, with a confirmed viral diagnosis on polymerase chain reaction (PCR) testing. Children with co-morbidities were excluded. Data collected included demographics, fluid status, diuretic use, morbidity and outcomes. The data were compared between groups that received or did not receive diuretics.


Result
 Of the 224 mechanically ventilated children with confirmed bronchiolitis, 179 (79%) received furosemide on Day 2 of invasive ventilation. Out of these, 72% of the patients received intermittent intravenous furosemide, whereas 28% received continuous infusion. It was used more commonly in patients who had a higher fluid overload. Initial fluid overload was associated with longer duration of mechanical ventilation (median days 6 vs 4, p<0.001) and length of stay (median days 10 vs 6, p<0.001) even with the use of furosemide. Superimposed bacterial pneumonia was seen in 60% of cases and was associated with a higher per cent fluid overload at 24 hours (9.1 vs 6.3, p = 0.003).


Conclusion
 Diuretics are frequently used in mechanically ventilated children with bronchiolitis and fluid overload, with intermittent dosing of furosemide being the commonest treatment. There is a potential benefit of improved oxygenation in these children, though further research is needed to quantify this benefit and any potential harm. Due to potential harm with fluid overload, restrictive fluid strategies may have a potential benefit.

The Use of Diuretic in Mechanically Ventilated Children with Viral Bronchiolitis: A Cohort Study

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution 4.0 International License.

Introduction
Viral bronchiolitis is a leading cause of admissions to pediatric intensive care unit (PICU). A literature review indicates that there is limited...

The Use of Diuretic in Mechanically Ventilated Children with Viral Bronchiolitis: A Cohort Study

Article Category: Research Article

Published Online: May 12, 2021

Page range: 97 - 103

Received: Nov 28, 2020

Accepted: Jan 31, 2021

DOI: https://doi.org/10.2478/jccm-2021-0008

Keywords
furosemide, mechanical ventilation, bronchiolitis

© 2021 Nisha Agasthya, Kimberlee Chromey, James H. Hertzog, Jigar C. Chauhan, published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

The Use of Diuretic in Mechanically Ventilated Children with Viral Bronchiolitis: A Cohort Study

Article Category: Research Article

Published Online: May 12, 2021

Page range: 97 - 103

Received: Nov 28, 2020

Accepted: Jan 31, 2021

DOI: https://doi.org/10.2478/jccm-2021-0008

Keywordsfurosemide, mechanical ventilation, bronchiolitis

© 2021 Nisha Agasthya, Kimberlee Chromey, James H. Hertzog, Jigar C. Chauhan, published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Keywords
furosemide, mechanical ventilation, bronchiolitis