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Efficacy of an extravascular lung water-driven negative fluid balance protocol

Medicina intensiva, 2015-08, Vol.39 (6), p.345-351 [Peer Reviewed Journal]

Elsevier España, S.L.U. and SEMICYUC ;2014 Elsevier España, S.L.U. and SEMICYUC ;Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved. ;ISSN: 0210-5691 ;EISSN: 1578-6749 ;DOI: 10.1016/j.medin.2014.07.008 ;PMID: 25305240

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Title:
Efficacy of an extravascular lung water-driven negative fluid balance protocol
Author: Díaz-Rubia, L ; Ramos-Sáez, S ; Vázquez-Guillamet, R ; Guerrero-López, F ; Pino-Sánchez, F ; García-Delgado, M ; Gómez-Jiménez, F.J ; Fernández-Mondéjar, E
Subjects: Acute lung injury ; Acute Lung Injury - complications ; Acute Lung Injury - physiopathology ; Acute Lung Injury - therapy ; Acute respiratory distress syndrome ; Adult ; Aged ; Agua pulmonar extravascular ; Balance hídrico negativo ; Clinical Protocols ; Critical Care ; Extravascular lung water ; Extravascular Lung Water - physiology ; Female ; Fluid Therapy - methods ; Hemodynamics ; Humans ; Hypoxemic patients ; Hypoxia - etiology ; Hypoxia - physiopathology ; Hypoxia - therapy ; Intensive Care Unit ; Lesión pulmonar aguda ; Male ; Middle Aged ; Monitoring, Physiologic ; Negative fluid balance ; Pacientes hipoxémicos ; Pulmonary Edema - etiology ; Pulmonary Edema - physiopathology ; Pulmonary Edema - prevention & control ; Pulmonary Gas Exchange ; Pulmonary Wedge Pressure ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult - complications ; Respiratory Distress Syndrome, Adult - physiopathology ; Respiratory Distress Syndrome, Adult - therapy ; Sepsis - complications ; Síndrome de distress respiratorio agudo ; Thermodilution ; Unidad Cuidados Intensivos ; Water-Electrolyte Balance
Is Part Of: Medicina intensiva, 2015-08, Vol.39 (6), p.345-351
Description: Abstract Objective To analyze the efficacy of negative fluid balance in hypoxemic patients with an elevated extravascular lung water index (EVLWI). Design A retrospective observational study was made. Setting Intensive Care Unit of Virgen de las Nieves Hospital (Spain). Participants Forty-four patients participated in the study. Interventions We analyzed our database of hypoxemic patients covering a period of 11 consecutive months. We included all hemodynamically stable and hypoxemic patients with EVLWI > 9 ml/kg. The protocol dictates a negative fluid balance between 500 and 1500 ml/day. We analyzed the impact of this negative fluid balance strategy upon pulmonary, hemodynamic, and renal function. Main variables of interest 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 210 mm Hg (IQR 164, 248) ( p < 0.001), and EVLWI decreased from 14 (11, 18) to 10 ml/kg (8, 14) ( p < 0.001). In the PFB group, EVLWI also decreased from 11 (10, 14) to 10 ml/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 216 mm Hg (IQR 137, 260) at the beginning versus 205 mm Hg (IQR 99,257) at the end of the study ( p = 0.08). Conclusion 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.
Publisher: Spain: Elsevier España, S.L.U
Language: English
Identifier: ISSN: 0210-5691
EISSN: 1578-6749
DOI: 10.1016/j.medin.2014.07.008
PMID: 25305240
Source: Geneva Foundation Free Medical Journals at publisher websites
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Efficacy of an extravascular lung water-driven negative fluid balance protocol

Elsevier España, S.L.U. and SEMICYUC ;2014 Elsevier España, S.L.U. and SEMICYUC ;Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved. ;ISSN: 0210-5691 ;EISSN: 1578-6749 ;DOI: 10.1016/j.medin.2014.07.008 ;PMID: 25305240

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