UMEM Educational Pearls


Fluid overload (defined in this study as (fluid input-output)/weight)) is associated with longer hospital stays, longer treatment duration and oxygen use.

Bottom line: Treat dehydration appropriately but try not to over resuscitate the asthmatic.  Further studies are needed before definitive recommendations are made.



This was a retrospective cohort study over 7 years at a single children’s hospital.  Children included were older than 6 years and were admitted with no pneumonia or history of chronic lung disease.  Fluid intake and output were collected for the initial 72 hours of hospitalization or discharge.  The study included 1175 encounters.  On average, 1% increase in fluid overload was associated with about a 7 hour increase in hospital stay, 6 hours longer of beta agonist and 2 hours longer of supplemental oxygen.  Fluid overload of more than 7% was determined to be clinically meaningful showing an increased risk of requiring supplemental oxygen and non-invasive pressure ventilation.  One of the limitations of this study that the authors mention is that the weight they used is the admission weight and the patient may already be dehydrated, thereby overestimating fluid overload.


Kantor et al.  Fluid balance is Associated with Clinical Outcomes and Extravascular Lung Water in Children with Acute Asthma Exacerbation.  American Journal of Respiratory and Critical Care Medicine.  Epub ahead of print, Jan 9, 2018.