Effect Of Different Fluid-management Strategies On Extravascular Lung Water In The Patients With Acute Respiratory Distress Syndrome

Acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is a kind of severe hypoxemic respiratory failure, the development of which is related to trauma, aspiration, shock, infection and other critical illness.In the early stage of ARDS, the increase of alveolar-capillary barrier permeability leads to fluid accumulation in alveolars. If not adjusting the fluid balance, it will lead to pulmonary edema, respiratory failure and continue mechanical ventilation. It is difficult to banlance adequate volume resuscitation and to avoid aggravating pulmonary edema. For a long time, clinicians always managed hemodynamics of ARDS patients by monitoring the pulmonary arterial wedge pressure (PAWP) and central venous pressure (CVP). But because of the effects of changes in pulmonary capillary permeability, the CVP and PAWP can not reflect changes of pulmonary edema. The extravascular lung water (EVLW) is not effected by the pulmonary capillary permeability and can directly reflect the severity of pulmonary edema. Controlling and reducing EVLW can prevent or treat pulmonary edema, increase survival rate of ARDS patients.In our study, we explore the effect of different fluid-management strategies on EVLWI in ARDS patients and try to find a simple, effective approach to reduce EVLW.Methods and ResultsSelected 40 patients who meet the inclusion criteria were research objects, they went into Affiliated Zhongshan Hospital of Dalian University, Intensive Care Unit. They were randomly assigned to a strategy involving either conservative or liberal fluid-management strategy group. The patients were given scores including general conditions, APACHE II score counted by software. All the patients implemented invasive mechanical ventilation according the lung protective ventilation strategies and implemented early goal-directed therapy according the sepsis bundle recommended in'international guidelines for management of severe sepsis and septic shock (2008)'. All the patients accomplished hemodynamic optimization and achieved the recovery target in 6 hours. Indwelling the central venous catheter and femoral artery catheter in 2 hours into the ICU. Central venous pressure, mean arterial pressure, cardiac index, urinary output and extravascular lung water index (EVLWI) were measured. Reassessing patients at least every 4 hours and recording the above variables. Measuring arterial blood gas analysis (ABG) according the condition of the patients. When the patients was in the stable condition, the ABG should be measured every 12 hours. All the patients should be monitored 7 days and recorded the volume of fluid intake, output and fluid balance everyday. The patients'fluid management should according to the schedule program. Statistical methods is used to evaluate the relationship between different fluid-management strategies and the extravascular lung water (EVLW) and explored the effects of different fluid-management strategies on EVLW. The result shows that the reduce of the conservative fluid-management strategy group patients'EVLW faster than that of the liberal fluid-management strategy group patients'. The conservative fluid-management strategy can reduce ARDS patients'EVLW and improve the pulmonary function.ConclusionThe conservative fluid-management strategy is a effective approach to reduce EVLW.