Fluid administration and monitoring in ARDS: which management?

Vignon, Philippe; Evrard, Bruno; Asfar, Pierre; Busana, Mattia; Calfee, Carolyn S.; Coppola, Silvia; Demiselle, Julien; Géri, Guillaume; Jozwiak, Mathieu; Martin, Greg S.; Gattinoni, Luciano; Chiumello, Davide

doi:10.1007/s00134-020-06310-0

Cited by 79 publications

(66 citation statements)

References 73 publications

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“…Patients were managed according to recommendations from published guidelines on protective mechanical ventilation and pharmacologic treatment of ARDS. 23 , 24 , 25 , 26 , 27 In particular, the authors aimed for a tidal volume of 6-to-8 mL/kg of ideal body weight, a driving pressure of ≤15 cmH 2 O, and a pH >7.25. Positive end-expiratory pressure (PEEP) initially was set according to the ARDSnet low PEEP/high F i0 2 table, and then individualized according to oxygenation, respiratory system mechanics, and hemodynamics.…”

Section: Methodsmentioning

confidence: 99%

Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients

Belletti

Palumbo

Zangrillo

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

106

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Objective To determine the incidence, predictors, and outcome of pneumothorax (PNX)/pneumomediastinum (PMD) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS). Design Observational study. Setting Tertiary-care university hospital. Participants One hundred sixteen consecutive critically ill, invasively ventilated patients with COVID-19 ARDS. Interventions The authors collected demographic, mechanical ventilation, imaging, laboratory, and outcome data. Primary outcome was the incidence of PNX/PMD. Multiple logistic regression analyses were performed to identify predictors of PNX/PMD. Measurements and Main Results PNX/PMD occurred in a total of 28 patients (24.1%), with 22 patients developing PNX (19.0%) and 13 developing PMD (11.2%). Mean time to development of PNX/PMD was 14 ± 11 days from intubation. The authors found no significant difference in mechanical ventilation parameters between patients who developed PNX/PMD and those who did not. Mechanical ventilation parameters were within recommended limits for protective ventilation in both groups. Ninety-five percent of patients with PNX/PMD had the Macklin effect (linear collections of air contiguous to the bronchovascular sheaths) on a baseline computed tomography scan, and tended to have a higher lung involvement at intensive care unit (ICU) admission (Radiographic Assessment of Lung Edema score 32.2 ± 13.4 v 18.7 ± 9.8 in patients without PNX/PMD, p = 0.08). Time from symptom onset to intubation and time from total bilirubin on day two after ICU admission were the only independent predictors of PNX/PMD. Mortality was 60.7% in patients who developed PNX/PMD versus 38.6% in those who did not (p = 0.04). Conclusion PNX/PMD occurs frequently in COVID-19 patients with ARDS requiring mechanical ventilation, and is associated with increased mortality. Development of PNX/PMD seems to occur despite use of protective mechanical ventilation and has a radiologic predictor sign.

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Section: Methodsmentioning

confidence: 99%

Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients

Belletti

Palumbo

Zangrillo

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

106

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“…However, the impact on mortality currently remains unclear [ 128 ]. In patients with ARDS, fluid administration to increase tissue oxygenation must be carefully balanced against the potential impact on pulmonary edema and risk of impaired gas exchange [ 133 ]. A recently published review suggests using a restrictive fluid regime in ARDS patients without shock while carefully monitoring hemodynamic indices, fluid responsiveness, and general fluid status [ 133 ].…”

Section: Clinical Presentationmentioning

confidence: 99%

“…In patients with ARDS, fluid administration to increase tissue oxygenation must be carefully balanced against the potential impact on pulmonary edema and risk of impaired gas exchange [ 133 ]. A recently published review suggests using a restrictive fluid regime in ARDS patients without shock while carefully monitoring hemodynamic indices, fluid responsiveness, and general fluid status [ 133 ]. In fluid-overloaded ARDS patients without shock, active fluid removal with diuretics or renal replacement therapies should be considered until euvolemia is achieved [ 88 ].…”

Section: Clinical Presentationmentioning

confidence: 99%

COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment – A narrative review

Pfortmueller

Spinetti

Urman

et al. 2021

Best Practice & Research Clinical Anaesthesiology

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“… 45 Positive-pressure ventilation and increased pulmonary vascular constriction can independently increase fluid retention and interstitial edema regardless of fluid administration. 46 Based on recent randomized controlled trials and meta-analysis, a fluid restrictive strategy remains the preferred management, with benefits including enhanced oxygenation, fewer days on mechanical ventilation, and fewer days in the ICU. 46 , 47 A recent, large retrospective study has also suggested mortality benefit with a fluid restrictive strategy.…”

Section: Validated Ards Therapies: Lung Protective Ventilation (Lpv)mentioning

confidence: 99%

“… 46 Based on recent randomized controlled trials and meta-analysis, a fluid restrictive strategy remains the preferred management, with benefits including enhanced oxygenation, fewer days on mechanical ventilation, and fewer days in the ICU. 46 , 47 A recent, large retrospective study has also suggested mortality benefit with a fluid restrictive strategy. 48 While there is no consensus on specific fluid restriction goals, limiting maintenance intravenous fluids and active diuresis are common clinical practices.…”

Section: Validated Ards Therapies: Lung Protective Ventilation (Lpv)mentioning

confidence: 99%

2021 Acute Respiratory Distress Syndrome Update, With Coronavirus Disease 2019 Focus

Welker

Huang

Gil

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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Acute Respiratory Distress Syndrome (ARDS) is a heterogeneous lung disease responsible for significant morbidity and mortality among critically ill patients, including those infected with SARS-CoV-2, the virus responsible for COVID-19. Despite recent advances in pathophysiology, diagnostics, and therapeutics, ARDS is dangerously underdiagnosed and supportive lung protective ventilation and prone position remain the mainstay intervention. Rescue therapies including neuromuscular blockade and veno-venous extracorporeal membrane oxygenation (VV-ECMO) remain a key component of clinical practice though benefits are uncertain. While COVID-19 ARDS has some distinguishing features from traditional ARDS, including delayed onset, hyperinflammatory response, and pulmonary microthrombi, it is clinically similar to traditional ARDS and should be treated with established supportive therapies.

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Fluid administration and monitoring in ARDS: which management?

Cited by 79 publications

References 73 publications

Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients

Predictors of Pneumothorax/Pneumomediastinum in Mechanically Ventilated COVID-19 Patients

COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment – A narrative review

2021 Acute Respiratory Distress Syndrome Update, With Coronavirus Disease 2019 Focus

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