Cumulative fluid balance predicts mortality and increases time on mechanical ventilation in ARDS patients: An observational cohort study


Autoři: Niels van Mourik aff001;  Hennie A. Metske aff001;  Jorrit J. Hofstra aff002;  Jan M. Binnekade aff002;  Bart F. Geerts aff001;  Marcus J. Schultz aff002;  Alexander P. J. Vlaar aff002
Působiště autorů: Department of Anaesthesiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands aff001;  Department of Intensive Care Medicine, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224563

Souhrn

Introduction

Acute respiratory distress syndrome (ARDS) is characterized by acute, diffuse, inflammatory lung injury leading to increased pulmonary vascular permeability, pulmonary oedema and loss of aerated tissue. Previous literature showed that restrictive fluid therapy in ARDS shortens time on mechanical ventilation and length of ICU-stay. However, the effect of intravenous fluid use on mortality remains uncertain. We investigated the relationship between cumulative fluid balance (FB), time on mechanical ventilation and mortality in ARDS patients.

Materials and methods

Retrospective observational study. Patients were divided in four cohorts based on cumulative FB on day 7 of ICU-admission: ≤0 L (Group I); 0–3.5 L (Group II); 3.5–8 L (Group III) and ≥8 L (Group IV). In addition, we used cumulative FB on day 7 as continuum as a predictor of mortality. Primary outcomes were 28-day mortality and ventilator-free days. Secondary outcomes were 90-day mortality and ICU length of stay.

Results

Six hundred ARDS patients were included, of whom 156 (26%) died within 28 days. Patients with a higher cumulative FB on day 7 had a longer length of ICU-stay and fewer ventilator-free days on day 28. Furthermore, after adjusting for severity of illness, a higher cumulative FB was associated with 28-day mortality (Group II, adjusted OR (aOR) 2.1 [1.0–4.6], p = 0.045; Group III, aOR 3.3 [1.7–7.2], p = 0.001; Group IV, aOR 7.9 [4.0–16.8], p<0.001). Using restricted cubic splines, a non-linear dose-response relationship between cumulative FB and probability of death at day 28 was found; where a more positive FB predicted mortality and a negative FB showed a trend towards survival.

Conclusions

A higher cumulative fluid balance is independently associated with increased risk of death, longer time on mechanical ventilation and longer length of ICU-stay in patients with ARDS. This underlines the importance of implementing restrictive fluid therapy in ARDS patients.

Klíčová slova:

Acute respiratory distress syndrome – Death rates – Dose prediction methods – Edema – Chronic obstructive pulmonary disease – Intensive care units – Observational studies – Sepsis


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Článek vyšel v časopise

PLOS One


2019 Číslo 10