Fluid management in ARDS patients presents a real challenge and no definite guidelines exist to date. Few studies have shown that a liberal approach to fluid replacement in these patients may even have detrimental effects.To determine the impact of cumulative fluid balance and average fluid balance on morbidity and mortality rate of ICU patients with ARDS.
Retrospective chart analysis of all ARDS patients admitted to ICU within a two year period from January 2006 to December 2008. Data collection include demographics, admission diagnoses, criteria used to verify the diagnosis of ARDS, cumulative fluid balance within the first 7 days (CFB7), average daily fluid balance throughout the ICU stay (AFB), length of stay (LOS), number of days on ventilator (VD), number of organ dysfunction (OD) and final outcome. Patients were divided into two groups based on amount of fluid they were given. Patients whose CFB7 was < 10L on day 7 or AFB of < 1.4L per day throughout ICU stay were considered to be treated conservatively compared to those with > 10L on day 7 and AFB > 1.4L per day were considered to be treated liberally.
47-ARDS patients’-charts were reviewed.The overall-mortality rate was = 51%. The mortality-rate in patients with CFB7 < 10L was 22% compared to 69% in those with-CFB7 > 10L (p-value = 0.027). In patients with AFB < 1.4L/day, 22% of patients died-versus-90% of those who received more than 1.4L/day (p-value < 0.0001). Also, patients with CFB7of < 10L, had LOS-averaging 19-days, VD of 11-days,average OD = 0.6 compared to 24-days, 19-days, and 1.8 respectively for those with CFB7 > 10L (P-values:0.350, 0.040 & 0.002 respectively). Using AFB throughout the ICU-stay; the conservative-group who received less than 1.4L/d; had VD of 15 and average-OD of 0.74 vs 18&2.2 in the liberal-group (P-values:0.561 & 0.001 respectively). Interestingly, liberal-fluid management (using CFB7 or AFB) resulted in a higher number of patients requiring hemodialysis compared to the conservative-group.
ARDS-patients have increased mortality-rate if their CFB7 is > 10L or if their AFB > 1.4L/day.Patients with ARDS who are managed with fluids liberally ( > 10L-at-day7or > 1.4L-AFB) have increased risk of development of organ-dysfunction. Liberal-fluid management (CFB7 > 10L) in ARDS is associated with increased number of-VD.
Liberal-fluid balance strategy should be avoided in ARDS-patients due to higher morbidity&mortality.
Katarzyna Lechliter, No Financial Disclosure Information; No Product/Research Disclosure Information