title: Restrictive Fluid Resuscitation Leads to Better Oxygenation than Non-Restrictive Fluid Resuscitation in Piglets with Pulmonary or Extrapulmonary Acute Respiratory Distress Syndrome.
abstract: BACKGROUND
  Early goal-directed therapy (EGDT) is used to reduce mortality from septic shock and could be used in early fluid resuscitation of acute respiratory distress syndrome (ARDS). The aim of the present study was to assess the effects of restrictive (RFR) and nonrestrictive fluid resuscitation (NRFR) on hemodynamics, oxygenation, pulmonary function, tissue perfusion, and inflammation in piglets with pulmonary or extrapulmonary ARDS (ARDSp and ARDSexp).
  
  
  METHODS
  Chinese miniature piglets (6-8 weeks; 15 ± 1 kg) were randomly divided into 2 groups (n=12/group) for establishing ARDSp and ARDSexp models, and were further divided into 2 subgroups (n=6/subgroup) for performing RFR and NRFR. Piglets were anesthetized and hemodynamic, pulmonary, and oxygenation indicators were collected at different time points for 6 hours. The goal of EGDT was set for PiCCO parameters (mean arterial pressure (MAP), urine output and cardiac index (CI), and central venous oxygen saturation (ScvO2).
  
  
  RESULTS
  Piglets under RFR had lower urine output compared with NRFR, as well as lower total fluid volume (P<0.05). EVLW was decreased in ARDSp+RFR and NRFR, as well as in ARDSexp+RFR, but EVLW increased in ARDSexp+NRFR (P<0.05). PaO2/FiO2 decreased in ARDSp using both methods, but was higher with RFR (P<0.05), and was increased in ARDSexp+RFR. Other pulmonary indicators were comparable. The anti-inflammatory cytokines IL-10 and LXA4 were increased in ARDSexp after RFR (P<0.05), but not in the other groups.
  
  
  CONCLUSIONS
  RFR led to better oxygenation in ARDSp and ARDSexp compared with NRFR, but fluid restriction improved oxygenation in ARDSexp only.
authors.affiliation: Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland).
authors.forename: Shunan
authors.initials: S
authors.lastname: Ye
authors.affiliation: Department of Anesthesiology, Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, Shandong, China (mainland).
authors.forename: Qiujie
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Anesthesiology and Critical Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland).
authors.forename: Shiying
authors.initials: S
authors.lastname: Yuan
authors.affiliation: Department of Anesthesiology and Critical Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland).
authors.forename: Huaqing
authors.initials: H
authors.lastname: Shu
authors.affiliation: Department of Anesthesiology and Critical Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (mainland).
authors.forename: Yin
authors.initials: Y
authors.lastname: Yuan
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D005440:Fluid Therapy; D010100:Oxygen / Q000097:blood*; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D013552:Swine; D013556:Swine, Miniature
chemical_list: D010100:Oxygen