title: Echocardiography to predict tolerance to negative fluid balance in acute respiratory distress syndrome/acute lung injury.
abstract: OBJECTIVE
  In acute respiratory distress syndrome (ARDS) and acute lung injury (ALI), a conservative fluid management strategy improves lung function but could jeopardize extrapulmonary organ perfusion. The objective was to evaluate the diagnostic accuracy of echocardiography to predict tolerance of negative fluid balance (NFB) in patients with ARDS/ALI.
  
  
  METHODS
  A prospective and observational study in an adult intensive care unit of a university hospital was conducted. All hemodynamically stable patients with ARDS/ALI were included. Echocardiography was performed before NFB and again after 24 hours. Tolerance of NFB was evaluated by the presence of hypotension, acute kidney injury, or need for fluid expansion. The 2 patient groups (tolerating and not tolerating NFB) were compared.
  
  
  RESULTS
  Forty-five patients were included. Median age (Q1-Q3) was 58 (52-66) years, and the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen was 205 (163-258) mm Hg. Negative fluid balance was 1950 (1200-2200) mL within 24 hours in the tolerant group. Complications of NFB were observed in 35% cases. After univariate and multivariate logistic regression analyzes, 2 criteria was independently associates with poor tolerance: mitral inflow E wave to early diastolic mitral annulus velocities ratio (E/Ea ratio; odds ratio, 2.02 [1.02-4.02]; P = .04) and weight gain (odds ratio, 1.2 [1.03-1.4]; P = .02). The area under receiver operating characteristic curves was 0.74 for E/Ea and 0.77 for weight gain.
  
  
  CONCLUSIONS
  The ratio of E/Ea accurately predicted tolerance of NFB in patients with ARDS/ALI.
authors: Département Anesthésie Réanimation, AP-HP, Hop Bichat-Claude Bernard, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, Paris, France. Electronic address: allyn.jer@gmail.com.
authors: Jerome
authors: J
authors: Allyn
authors: Nicolas
authors: N
authors: Allou
authors: Marc
authors: M
authors: Dib
authors: Parvine
authors: P
authors: Tashk
authors: Mathieu
authors: M
authors: Desmard
authors: Guillaume
authors: G
authors: Dufour
authors: Omar
authors: O
authors: Daoud
authors: Hervé
authors: H
authors: Mentec
authors: Philippe
authors: P
authors: Montravers
mesh_terms: D018806:APACHE; D055371:Acute Lung Injury / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D000368:Aged; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D012129:Respiratory Function Tests; D014882:Water-Electrolyte Balance / Q000502:physiology*
keywords: ALI; ARDS; ARF; Acute lung injury; Acute respiratory distress syndrome; Doppler; E/A; E/Ea; Echocardiography; ICU; IVC; NFB; PAOP; Pao(2)/Fio(2); ROC; RRT; SAPS II; Simplified Acute Physiology Score II; TTE; WG; Water-electrolyte balance/physiology; acute lung injury; acute respiratory distress syndrome; acute respiratory failure; inferior vena cava; intensive care unit; mitral inflow E wave to early diastolic mitral annulus velocities ratio; mitral inflow E wave to mitral inflow A wave velocities ratio; negative fluid balance; pulmonary artery occlusion pressure; ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen; receiver operating characteristic; renal replacement therapy; transthoracic echocardiography; weight gain