Fluid Management In Acute Respiratory Distress Syndrome

Introduction: A non cardiogenic pulmonary edema is a hallmark of acuterespiratory distress syndrome. Fluid management is one of the most challenging taskin the treatment of ARDS.As already fluid settled inside the lungs making themanagement more challenging, however in order to maintain the hemodynamic of thebody fluid installation is an important task. How much fluid is adequate and whichfluid should be given priority is still not widely known. Therefore we tried to assessthe type of fluid and amount in the patients with ARDS. Colloid and crystalloid aretwo different types of fluids being used in a daily practice. Colloid remainsintravascular where as crystalloid not.Methods: Retrospective analysis of total43patients with ARDS who were beingtreated in the intensive care unit (ICU) of the second hospital, Jilin University dated2012.01-2012.06. Volume and the type of fluid used and its effect over24and72hours after admission were recorded where SOFA score, lactate level, oxygenationindex (PaO2/FiO2), platelet count, GCS score, bilirubin level, creatinine level, bloodurea nitrogen, blood pressure were carefully monitored. Duration of ICU stay andtotal ventilator days were recorded. Continuous renal replacement therapy (CRRT)needed or not was watched and the duration was recorded. Complete set of drugs usedduring and after the discharge from the hospital was carefully noted. Finally90daysmortality was recorded.Results:1. The volume more than3000mL administered group over24hours seems to bea bad prognosis. Increasing in volume has shown effect on increased in SOFAscore (P <0.05), lactate level, total ventilator days, total ICU stay, CRRT (P<0.05) and finally mortality.2. Patients group whom more than8000ml of fluid was administered over72hours has shown increased in SOFA score, lactate level, but still P remainedgreater than0.05. However there was decreased in PaO2/FiO2ratio over24hours (P=0.05). 3. Compared to the crystalloid alone and the mixture of colloid and crystalloidused over the first24hours, the result came out to be the effect of mixtureused is not very useful as SOFA score over72hours has increased(P <0.05)and the CRRT use was prolonged (P=0.05).4. Patients group having albumin for24hours compared to the opposite groupfound to have no obvious difference.5. Given plasma for24hours patients mortality rate was higher (P=0.05) and72hours SOFA score raised high P=0.01compare to the other group whereplasma was not given.6. Effect of HES found to be not satisfactory. Patients group under HES for24hours has increased mortality P<0.05.Lactate level in24and72hours hasincreased P<0.05.SOFA score were raised in both24and72hours P<0.05compared to those patients group not under HES.CRRT has to be used in thosepatients whom HES was used (P=0.05) and PaO2/FiO2ratio over24hourswas decreased (P=0.05).7. In only colloid given patients the volume has a significant effect, given≥1000ml of colloid has effect in SOFA (P=0.01) over72hours, mortalityincreased P=0.05,Lactate level increased (P=0.04),CRRT has to be used inthose patients who were on≥1000ml of colloid (P=0.05).PaO2/FiO2ratioover72hours found to be decreased significantly in those patients whom≥1000ml of colloid had given(P=0.04)Conclusions: Limit the total amount of fluid less than3000mL for the first24h or8000mL for72h to the patients having ARDS provides good in prognosis.Maintenance of relatively stable blood pressure by limiting fluid therapy reflects theprognosis of patients. In this context crystalloid seems superior to colloid. Adverseprognosis could be occurred by the use of high volume of colloid over the first24hours.