title: Efficacy of an extravascular lung water-driven negative fluid balance protocol.
abstract: OBJECTIVE
  To analyze the efficacy of negative fluid balance in hypoxemic patients with an elevated extravascular lung water index (EVLWI).
  
  
  METHODS
  A retrospective observational study was made.
  
  
  METHODS
  Intensive Care Unit of Virgen de las Nieves Hospital (Spain).
  
  
  METHODS
  Forty-four patients participated in the study.
  
  
  METHODS
  We analyzed our database of hypoxemic patients covering a period of 11 consecutive months. We included all hemodynamically stable and hypoxemic patients with EVLWI>9ml/kg. The protocol dictates a negative fluid balance between 500 and 1500ml/day. We analyzed the impact of this negative fluid balance strategy upon pulmonary, hemodynamic, and renal function.
  
  
  METHODS
  Demographic data, severity scores, clinical, hemodynamic, pulmonary, metabolic and renal function data.
  
  
  RESULTS
  Thirty-three patients achieved negative fluid balance (NFB group) and 11 had a positive fluid balance (PFB group). In the former group, PaO2/FiO2 improved from 145 (IQR 106, 200) to 210mmHg (IQR 164, 248) (p<0.001), and EVLWI decreased from 14 (11, 18) to 10ml/kg (8, 14) (p<0.001). In the PFB group, EVLWI also decreased from 11 (10, 14) to 10ml/kg (8, 14) at the end of the protocol (p=0.004). For these patients there were no changes in oxygenation, with a PaO2/FiO2 of 216mmHg (IQR 137, 260) at the beginning versus 205mmHg (IQR 99,257) at the end of the study (p=0.08).
  
  
  CONCLUSIONS
  Three out of four hypoxic patients with elevated EVLWI tolerated the NFB protocol. In these subjects, the improvement of various analyzed physiological parameters was greater and faster than in those unable to complete the protocol. Patients who did not tolerate the protocol were usually in more severe condition, though a larger sample would be needed to detect specific characteristics of this group.
authors.affiliation: Intensive Care Unit, Virgen de las Nieves Hospital, Granada, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Díaz-Rubia
authors.affiliation: Intensive Care Unit, Virgen de las Nieves Hospital, Granada, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Ramos-Sáez
authors.affiliation: Pulmonary and Critical Care Department, University of New Mexico, United States.
authors.forename: R
authors.initials: R
authors.lastname: Vázquez-Guillamet
authors.affiliation: Intensive Care Unit, Virgen de las Nieves Hospital, Granada, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Guerrero-López
authors.affiliation: Intensive Care Unit, Virgen de las Nieves Hospital, Granada, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Pino-Sánchez
authors.affiliation: Intensive Care Unit, Virgen de las Nieves Hospital, Granada, Spain.
authors.forename: M
authors.initials: M
authors.lastname: García-Delgado
authors.affiliation: Departament of Medicine to Granada University, Granada, Spain.
authors.forename: F J
authors.initials: FJ
authors.lastname: Gómez-Jiménez
authors.affiliation: Intensive Care Unit, Virgen de las Nieves Hospital, Granada, Spain; Instituto de Investigación Biosanitaria (IBS), Granada, Spain. Electronic address: efermonde@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Fernández-Mondéjar
mesh_terms: D055371:Acute Lung Injury / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D015633:Extravascular Lung Water / Q000502:physiology; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011654:Pulmonary Edema / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011659:Pulmonary Gas Exchange; D011669:Pulmonary Wedge Pressure; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D018805:Sepsis / Q000150:complications; D013815:Thermodilution; D014882:Water-Electrolyte Balance
keywords: Acute lung injury; Acute respiratory distress syndrome; Agua pulmonar extravascular; Balance hídrico negativo; Extravascular lung water; Hypoxemic patients; Intensive Care Unit; Lesión pulmonar aguda; Negative fluid balance; Pacientes hipoxémicos; Síndrome de distress respiratorio agudo; Unidad Cuidados Intensivos