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.
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.
Rosenberg
Andrew L
AL
Departments of Anesthesiology and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA. arosen@med.umich.edu
Dechert
Ronald E
RE
Park
Pauline K
PK
Bartlett
Robert H
RH
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*