Do hypooncotic fluids for shock increase the risk of late-onset acute respiratory distress syndrome?
OBJECTIVE
In patients with shock, late-onset acute respiratory distress syndrome (ARDS) carries poor prognosis. Hypooncotic fluids may improve kidney function preservation, whereas hyperoncotic fluids may in theory decrease the risk of late-onset ARDS. Our objective was to determine whether predominant or exclusive use of crystalloids and/or hypooncotic colloids for shock resuscitation influenced the risk of late-onset ARDS. PARTICIPANT AND SETTINGS: International prospective cohort of consecutive adults who were free of ARDS on admission and who received fluid resuscitation for shock in 115 intensive care units (ICUs) during a 4-week period.


RESULTS
Severity scores, hemodynamic status, indication for fluids, risk factors for ARDS, plasma expander use, transfusions, and late-onset ARDS were recorded prospectively. Logistic regression models were tested to determine whether predominant or exclusive use of hypooncotic fluids was associated with higher incidence of late-onset ARDS. Of 905 patients, 81 [8.9%; 95% confidence interval (CI) 7.2-11.0] developed ARDS, with no difference between patients given only hypooncotic fluids (10.4%; 95% CI 7.6-13.7) and the other patients (7.7%; 95% CI 5.5-10.5; p = 0.16). Late-onset ARDS was significantly associated with sepsis [odds ratio (OR) 1.90; 95% CI 1.06-3.40], worse chest X-ray score at fluid initiation (1.55; 95% CI 1.27-1.91), positive fluid balance (1.06 per l; 95% CI 1.02-1.09), and greater transfusion volume (1.14 per l; 95% CI 1.01-1.29). The proportion of hypooncotic fluids in the plasma expander regimen was not associated with late-onset ARDS (1.01 per %; 95% CI 0.99-1.01).


CONCLUSIONS
Based on this observational study, there is no evidence that in patients with shock the use of hypooncotic fluids increases the risk of late-onset ARDS. This finding needs to be confirmed.
Schortgen
Frédérique
F
Service de réanimation médicale, AP-HP, Groupe Hospitalier Albert Chenevier-Henri Mondor, Créteil, 94000, France. frederique.schortgen@hmn.aphp.fr.|Faculté de Médecine, INSERM, U955, Créteil, 94000, France. frederique.schortgen@hmn.aphp.fr.
Girou
Emmanuelle
E
Unité de Contrôle, Epidémiologie et Prévention de l'Infection, AP-HP, Groupe Hospitalier Albert Chenevier-Henri Mondor, Créteil, 94000, France.|Faculté de Médecine, Université Paris 12, Créteil, 94000, France.
Deye
Nicolas
N
Réanimation Médicale et Toxicologique, APHP, Hôpital Lariboisière-Fernand Widal, Paris, France.
Brochard
Laurent
L
Service de réanimation médicale, AP-HP, Groupe Hospitalier Albert Chenevier-Henri Mondor, Créteil, 94000, France.|Faculté de Médecine, INSERM, U955, Créteil, 94000, France.|Faculté de Médecine, Université Paris 12, Créteil, 94000, France.
D000328:Adult; D000368:Aged; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D012769:Shock / Q000628:therapy*
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