Fluid Management in Acute Lung Injury and ARDS

Roch, Antoine; Guervilly, Christophe; Papazian, Laurent

doi:10.1007/978-3-642-10286-8_19

Cited by 6 publications

(10 citation statements)

References 48 publications

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“…However, their study population included significantly fewer Black patients (17.7% vs 35%), with no discussion regarding underlying history of CKD. The association between baseline renal impairment and mortality, predominantly in the ICU setting, is well documented (3, 4, 6, 11, 12). Additionally, patients with a net positive fluid balance may experience compounded negative effects, including increased morbidity and mortality (11–14).…”

Section: Discussionmentioning

confidence: 99%

Oliguria on the Day of Intubation Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome

Fadel

Murskyj

Asala

et al. 2022

Critical Care Explorations

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OBJECTIVES:To investigate the relationship between oliguric acute kidney injury (AKI) and mortality in patients with acute respiratory distress syndrome (ARDS). DESIGN: Retrospective cohort study.SETTING: This investigation took place at a single-center, tertiary referral multidisciplinary comprehensive healthcare hospital in metropolitan Detroit, Michigan. PATIENTS:Adult patients 18 years old or older hospitalized in the ICU and diagnosed with ARDS on mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Three hundred eight patients were included in the final analysis. Risk factors associated with mortality included advanced age (p < 0.001), increased body mass index (p = 0.008), and a history of chronic kidney disease (p = 0.023). Presence of AKI by day 1 of intubation, with elevated creatinine (p = 0.003) and oliguria (p < 0.001), was significantly associated with mortality. On multivariate analysis, advanced age (relative risk [RR], 1.02), urine output on the day of intubation (RR, 0.388), bicarbonate level (RR, 0.948), and Sequential Organ Failure Assessment severity score (RR, 1.09) were independently associated with mortality. A receiver operating characteristic curve identified a threshold urine output on the day of intubation of 0.7 mL/kg/hr (area under the curve, 0.75; p < 0.001) as most closely associated with inpatient mortality (i.e., urine output < 0.7 mL/kg/hr is associated with mortality). CONCLUSIONS:For patients with ARDS, oliguria on the day of intubation was independently associated with increased mortality. Urine output of less than 0.7 mL/kg/hr predicted 80% of inpatient deaths. These findings herald an augmented understanding of the role of urine output in medical decision-making and prognostication.

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Section: Discussionmentioning

confidence: 99%

Oliguria on the Day of Intubation Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome

Fadel

Murskyj

Asala

et al. 2022

Critical Care Explorations

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“…Aggravation of interstitial edema in organs such as the lungs and kidneys leads to impaired oxygenation and perfusion, which cause MOF. Therefore, fluid restriction may help patients with ARDS by reducing edema [16,26]. Some factors other than fluid balance have been shown to be associated with mortality.…”

Section: Jcs Discussionmentioning

confidence: 99%

Association between Cumulative Fluid Balance and Outcomes in Acute Respiratory Distress Syndrome Patients Treated with Extracorporeal Membrane Oxygenation

et al. 2021

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Background Extracorporeal membrane oxygenation (ECMO) has become increasingly accepted as a life-saving procedure for patients with severe acute respiratory distress syndrome (ARDS). This study investigated the relationship between cumulative fluid balance (CFB) and outcomes in adult ARDS patients treated with ECMO. Methods We retrospectively analyzed the data of adult ARDS patients who received ECMO between December 2009 and December 2019 at Korea University Anam Hospital. CFB was calculated during the first 7 days after ECMO initiation. The primary endpoint was 28-day mortality. Results The 74 patients were divided into survivor (n=33) and non-survivor (n=41) groups based on 28-day survival. Non-survivors showed a significantly higher CFB at 1–7 days (p<0.05). Cox multivariable proportional hazard regression revealed a relationship between CFB on day 3 and 28-day mortality (hazard ratio, 3.366; 95% confidence interval, 1.528–7.417; p=0.003). Conclusion In adult ARDS patients treated with ECMO, a higher positive CFB on day 3 was associated with increased 28-day mortality. Based on our findings, we suggest a restrictive fluid strategy in ARDS patients treated with ECMO. CFB may be a useful predictor of survival in ARDS patients treated with ECMO.

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“…ARDS is a clinical syndrome with several distinctive features: hypoxemia, pulmonary infiltrates, proteinaceous pulmonary edema, acute onset after known insults, and absence of elevated hydrostatic pressure as the cause. (Costa & Amato 2013;Force et al 2012) Great advances have been made in the management of ARDS in recent years (Roch et al 2011), and ventilation strategy is the most extensively studied. Among various ventilation strategies, low-tidal volume ventilation, prone position, and high positive end-expiratory pressure (PEEP) have shown promising results.…”

Section: Title Pagementioning

confidence: 99%

Peer Review #1 of "The association between fluid balance and mortality in patients with ARDS was modified by serum potassium levels: a retrospective study (v0.2)"

2015

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Background and objective: acute respiratory distress syndrome (ARDS) is characterized by pulmonary edema and may benefit from conservative fluid management. However, conflicting results exist in the literature. The study aimed to investigate the association between mean fluid balance and mortality outcome in ARDS patients who required invasive mechanical ventilation. Methods: The study was a secondary analysis of a prospectively collected dataset obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center. ARDS patients with invasive mechanical ventilation were eligible. Demographic and laboratory data were extracted from the dataset. Multivariable regression model was built by stepwise selection of covariates. Fractional polynomial approach was used to test the linearity of mean fluid balance in the model. Potential interactions of mean fluid balance with other variables were tested. Main results: A total of 282 patients were eligible for the analysis, including 61 non-survivors with a mortality rate of 21.6%. After stepwise regression analysis, mean fluid balance remained to be an independent predictor of death (OR: 1.00057; 95% CI: 1.00034-1.00080). Two-term model obtained using fractional polynomial analysis was not superior to the linear model. There was significant interaction between mean fluid balance and serum potassium levels (p=0.011). While the risk of death increased with increasing mean fluid balance at potassium levels of 1.9, 2.9 , 3.9 and 4.9 mmol/l, the risk decreased at potassium level of 5.9 mmol/l. Conclusion: The present study demonstrates that more positive fluid balance in the first 8 days is significantly associated with increased risk of death. However, the relationship between mean fluid balance and mortality can be modified by serum potassium levels. With hyperkalemia, more positive fluid balance is associated with reduced risk of death.

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Fluid Management in Acute Lung Injury and ARDS

Abstract: ARDS is particularly characterized by pulmonary edema caused by an increase in pulmonary capillary permeability.

Cited by 6 publications

References 48 publications

Oliguria on the Day of Intubation Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome

Oliguria on the Day of Intubation Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome

Association between Cumulative Fluid Balance and Outcomes in Acute Respiratory Distress Syndrome Patients Treated with Extracorporeal Membrane Oxygenation

Peer Review #1 of "The association between fluid balance and mortality in patients with ARDS was modified by serum potassium levels: a retrospective study (v0.2)"

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