The Association Between Early Fluid Strategy and Prognosis of Acute Respiratory Distress Syndrome: A Post Hoc Study of CHARDS

Overview

Journal Pulm Circ

Publisher Wiley

Specialty Pulmonary Medicine

Date 2023 Jul 5

PMID 37404902

Authors

Ziying Chen

Xu Huang

Haining Lu

Wang Deng

Linna Huang

Dawei Wu

Daoxin Wang

Qingyuan Zhan

Chen Wang

Affiliations

Soon will be listed here.

Abstract

We aimed to assess general fluid management in China and evaluate the association between fluid balance and survival outcomes in acute respiratory distress syndrome (ARDS) patients. A retrospective, multicenter study including ARDS patients was conducted. We described the fluid management of ARDS patients in China. Furthermore, clinical characteristics and outcomes of patients subdivided by cumulative fluid balance were also analyzed. Multivariable logistic regression analysis was performed with hospital mortality as the outcome. From June 2016 to February 2018, 527 ARDS patients were included in our study. The mean cumulative fluid balance was 1669 (-1101 to 4351) mL in the first 7 day after intensive care unit (ICU) admission. Patients were divided into four groups based on cumulative fluid balance of the first 7 day after ICU admission: Group I (≤0 L), Group II (>0 L, ≤3 L), Group III (>3 L, ≤5 L), and Group IV (>5 L). Significantly lower hospital mortality was observed in patients with a lower cumulative fluid balance on day 7 of ICU admission (20.5% in Group I vs. 32.8% in Group II, 38.5% in Group III, and 50% in Group IV, < 0.001). A lower fluid balance is associated with lower hospital mortality in patients with ARDS. However, a large-scale and well-designed randomized controlled trial is needed in the future.

Citing Articles

The association between early fluid strategy and prognosis of acute respiratory distress syndrome: A post hoc study of CHARDS.

Chen Z, Huang X, Lu H, Deng W, Huang L, Wu D Pulm Circ. 2023; 13(3):e12261.

PMID: 37404902 PMC: 10315445. DOI: 10.1002/pul2.12261.

References

Griffiths M, McAuley D, Perkins G, Barrett N, Blackwood B, Boyle A . Guidelines on the management of acute respiratory distress syndrome. BMJ Open Respir Res. 2019; 6(1):e000420. PMC: 6561387. DOI: 10.1136/bmjresp-2019-000420. View

Huppert L, Matthay M, Ware L . Pathogenesis of Acute Respiratory Distress Syndrome. Semin Respir Crit Care Med. 2019; 40(1):31-39. PMC: 7060969. DOI: 10.1055/s-0039-1683996. View

Del Sorbo L, Slutsky A . Acute respiratory distress syndrome and multiple organ failure. Curr Opin Crit Care. 2010; 17(1):1-6. DOI: 10.1097/MCC.0b013e3283427295. View

Sweeney R, McAuley D . Acute respiratory distress syndrome. Lancet. 2016; 388(10058):2416-2430. PMC: 7138018. DOI: 10.1016/S0140-6736(16)00578-X. View

Vieillard-Baron A, Girou E, Valente E, Brun-Buisson C, Jardin F, Lemaire F . Predictors of mortality in acute respiratory distress syndrome. Focus On the role of right heart catheterization. Am J Respir Crit Care Med. 2000; 161(5):1597-601. View

Sakr Y, Vincent J, Reinhart K, Groeneveld J, Michalopoulos A, Sprung C . High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury. Chest. 2005; 128(5):3098-108. DOI: 10.1378/chest.128.5.3098. View

Hu W, Lin C, Liu B, Hu W, Zhu Y . Extravascular lung water and pulmonary arterial wedge pressure for fluid management in patients with acute respiratory distress syndrome. Multidiscip Respir Med. 2014; 9(1):3. PMC: 3906773. DOI: 10.1186/2049-6958-9-3. View

Wiedemann H, Wheeler A, Bernard G, Thompson B, Hayden D, deBoisblanc B . Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006; 354(24):2564-75. DOI: 10.1056/NEJMoa062200. View

Martin G, Mangialardi R, Wheeler A, Dupont W, Morris J, Bernard G . Albumin and furosemide therapy in hypoproteinemic patients with acute lung injury. Crit Care Med. 2002; 30(10):2175-82. DOI: 10.1097/00003246-200210000-00001. View

10.

Ferguson N, Meade M, Hallett D, Stewart T . High values of the pulmonary artery wedge pressure in patients with acute lung injury and acute respiratory distress syndrome. Intensive Care Med. 2002; 28(8):1073-7. DOI: 10.1007/s00134-002-1354-y. View

11.

Grignola J, Domingo E . Acute Right Ventricular Dysfunction in Intensive Care Unit. Biomed Res Int. 2017; 2017:8217105. PMC: 5671685. DOI: 10.1155/2017/8217105. View

12.

Chen Z, Huang X, Lu H, Deng W, Huang L, Wu D . The association between early fluid strategy and prognosis of acute respiratory distress syndrome: A post hoc study of CHARDS. Pulm Circ. 2023; 13(3):e12261. PMC: 10315445. DOI: 10.1002/pul2.12261. View

13.

Zhang Z, Ni H, Qian Z . Effectiveness of treatment based on PiCCO parameters in critically ill patients with septic shock and/or acute respiratory distress syndrome: a randomized controlled trial. Intensive Care Med. 2015; 41(3):444-51. DOI: 10.1007/s00134-014-3638-4. View

14.

Reilly J, Calfee C, Christie J . Acute Respiratory Distress Syndrome Phenotypes. Semin Respir Crit Care Med. 2019; 40(1):19-30. PMC: 6657496. DOI: 10.1055/s-0039-1684049. View

15.

Perina D . Noncardiogenic pulmonary edema. Emerg Med Clin North Am. 2003; 21(2):385-93. DOI: 10.1016/s0733-8627(03)00020-8. View

16.

Zhou J, Qian C, Zhao M, Yu X, Kang Y, Ma X . Epidemiology and outcome of severe sepsis and septic shock in intensive care units in mainland China. PLoS One. 2014; 9(9):e107181. PMC: 4167333. DOI: 10.1371/journal.pone.0107181. View

17.

Thompson B, Chambers R, Liu K . Acute Respiratory Distress Syndrome. N Engl J Med. 2017; 377(6):562-572. DOI: 10.1056/NEJMra1608077. View

18.

Silversides J, Major E, Ferguson A, Mann E, McAuley D, Marshall J . Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis. Intensive Care Med. 2016; 43(2):155-170. DOI: 10.1007/s00134-016-4573-3. View

19.

Huang X, Zhang R, Fan G, Wu D, Lu H, Wang D . Incidence and outcomes of acute respiratory distress syndrome in intensive care units of mainland China: a multicentre prospective longitudinal study. Crit Care. 2020; 24(1):515. PMC: 7439799. DOI: 10.1186/s13054-020-03112-0. View

20.

Martin G, Moss M, Wheeler A, Mealer M, Morris J, Bernard G . A randomized, controlled trial of furosemide with or without albumin in hypoproteinemic patients with acute lung injury. Crit Care Med. 2005; 33(8):1681-7. DOI: 10.1097/01.ccm.0000171539.47006.02. View