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

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 ven...

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Published in:PloS one Vol. 14; no. 10; p. e0224563
Main Authors: van Mourik, Niels, Metske, Hennie A., Hofstra, Jorrit J., Binnekade, Jan M., Geerts, Bart F., Schultz, Marcus J., Vlaar, Alexander P. J.
Format: Journal Article
Language:English
Published: United States Public Library of Science 30.10.2019
Public Library of Science (PLoS)
Subjects:
Adult respiratory distress syndrome
Aeration
Aged
Analysis
Anesthesiology
Biology and Life Sciences
Care and treatment
Cohort analysis
Cohort Studies
Critical Care
Dose-response relationship
Edema
Female
Fluid therapy
Fluids
Hospitals
Humans
Inflammation
Intensive care
Intravenous administration
Lung diseases
Male
Mechanical ventilation
Medical research
Medicine
Medicine and Health Sciences
Middle Aged
Mortality
Nonlinear response
Observational studies
Patients
Permeability
Research and Analysis Methods
Respiration, Artificial - statistics & numerical data
Respiratory distress syndrome
Respiratory Distress Syndrome, Adult - mortality
Respiratory Distress Syndrome, Adult - physiopathology
Respiratory Distress Syndrome, Adult - therapy
Retrospective Studies
Sepsis
Splines
Studies
Systematic review
Therapy
Time
Ventilation
Ventilators
Water-Electrolyte Balance
Netherlands
ISSN:1932-6203, 1932-6203
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Summary: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. 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. 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. 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.
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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0224563