title: 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.
abstract: OBJECTIVE
  To evaluate the independent influence of fluid balance on outcomes for patients with acute lung injury.
  
  
  METHODS
  Secondary analysis of a prospective cohort study conducted between March 1996 and March 1999.
  
  
  METHODS
  The study involved 10 academic clinical centers (with 24 hospitals and 75 Intensive Care Units).
  
  
  METHODS
  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.
  
  
  METHODS
  The study had no interventions.
  
  
  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.
authors.affiliation: Departments of Anesthesiology and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA. arosen@med.umich.edu
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Rosenberg
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Dechert
authors.forename: Pauline K
authors.initials: PK
authors.lastname: Park
authors.forename: Robert H
authors.initials: RH
authors.lastname: Bartlett
mesh_terms: D055371:Acute Lung Injury / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015633:Extravascular Lung Water / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013990:Tidal Volume; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance / Q000502:physiology*