Expiratory flow limitation developed in ICU patients: relationship of fluid overload, respiratory mechanics, and outcome

Abstract

Dear editor, We read with great interest in the report by Volta and colleagues [1] about the presence and determinant of expiratory flow limitation (EFL) developed in patients admitted to an intensive care unit (ICU). They found that the presence of EFL is common among ICU patients requiring mechanical ventilation for acute respiratory failure of different etiologies. And interestingly, the major determinant for developing EFL in patients during the first 3 days of their ICU stay is a positive fluid balance. However, whether there is a relationship among fluid overload, respiratory mechanics, and outcome is controversial, and we would like to add some comments. First, in Volta et al.'s work [1], 37 (31%) patients exhibited EFL upon admission, of whom 76%, 57%, and 43% had heart diseases, COPD or ARDS, and higher BMI, respectively. It is easily explainable that obese patients and those with COPD, heart disease, or ARDS can exhibit EFL at ICU admission [2]. Therefore, it should be more important to focus on patients who might develop EFL during the ICU stay and its mechanism. Second, whether fluid overload is the mechanism of developing EFL during the ICU stay was not fully explained by Volta et al.'s data [1]. A decreased respiratory system compliance and an increased airway resistance should be related to fluid overload-induced pulmonary edema, pleural effusion, or small airway swelling and closure [3]. Of note, in Volta's study,

Mid-Regional Proadrenomedullin as a New Biomarker of Kidney and Cardiovascular Diseases—Is It the Future?

“…The MR-ProADM levels did not correlate with AKI incidents, but discriminated patients with high odds of death. The latest study of Liu et al [ 65 ] performed in a group of critically ill sepsis patients suggested that ADM may become a biomarker for rapid assessment of the presence and severity of AKI at an early stage.…”

The challenge of COVID-19 for a Clinical Microbiology Department

“…Several articles have been published analyzing adaptations required in emergency, radiology and intensive care departments ( Ashari et al, 2020 , Wee et al, 2020 , Vargas et al, 2020 ). However, we were not able to find virtually nothing about the great challenge that the pandemic has posed to Clinical Microbiology laboratories.…”

Factors Associated with Quality of Dying and Death in Korean Intensive Care Units: Perceptions of Nurses

“…There are restrictions on ensuring patient comfort in ICU, and specific methods may vary depending on the studies. However, the common emphasis in previous studies is that it is important to maintain the physical and mental comfort of the patient during the time of death and involve the patient and his or her family as soon as possible in this decision-making for treatment at the end of life [ 15 , 16 ].…”