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Review of A Large Clinical Series: Association of Cumulative Fluid Balance on Outcome in Acute Lung Injury: A Retrospective Review of the ARDSnet Tidal Volume Study Cohort

Departments of Anesthesiology and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, arosen{at}med.umich.edu

Ronald E. Dechert, DrPH

Department of Critical Care Support Services, University of Michigan Medical Center, Ann Arbor, Michigan

Pauline K. Park, MD

Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan

Robert H. Bartlett, MD

Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan

NIH NHLBI ARDS Network

Objective: To evaluate the independent influence of fluid balance on outcomes for patients with acute lung injury. Design: Secondary analysis of a prospective cohort study conducted between March 1996 and March 1999. Setting: The study involved 10 academic clinical centers (with 24 hospitals and 75 Intensive Care Units). Patients: All patients for whom fluid balance data existed (844) from the 902 patients enrolled in the National Heart Lung Blood Institute's ARDS Network ventilator-tidal volume trial. Interventions: The study had no interventions. Measurements/Results: On the first day of study enrollment, 683 patients were, on average, more than 3.5 L in positive fluid balance compared to 161 patients in negative fluid balance (P < .001). Cumulative negative fluid balance on day 4 of the study was associated with an independently lower hospital mortality (OR, 0.50; 95% CI, 0.28-0.89; P < .001) more ventilator and intensive care unit—free days. Conclusions: Negative cumulative fluid balance at day 4 of acute lung injury is associated with significantly lower mortality, independent of other measures of severity of illness.

Key Words: acute lung injury • ARDS • fluid management • ICU • outcomes assessment

This version was published on January 1, 2009

Journal of Intensive Care Medicine, Vol. 24, No. 1, 35-46 (2009)
DOI: 10.1177/0885066608329850


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