After careful consideration, the American Thoracic Society canceled its annual meeting that was to take place in Philadelphia, Pennsylvania from May 15-20, because of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Although the live events will not proceed as planned, our readers can still find coverage of research that was scheduled to be presented at the meeting. A virtual event is being planned for later this year.
In patients with acute respiratory distress syndrome (ARDS), a positive net fluid balance (NFB) is associated with increased odds of mortality and significantly more days of ventilation use compared with patients with ARDS and a negative NFB, according to study results intended to be presented at the American Thoracic Society (ATS) International Conference. (Select research is slated to be presented in a virtual format later this year.)
The study included 3370 adults who received mechanical ventilation who were admitted to an intensive care unit at 3 hospitals. A total of 1098 (33%) patients in this cohort had ARDS, according to an assessment based on the Berlin criteria following radiologic consensus training. The primary end point was the NFB 96 hours postintubation. Patients were stratified by shock (shock vs non-shock), defined by either vasopressor use or a mean arterial pressure (MAP) of <65 mm Hg.
Compared with patients without ARDS, those with ARDS had a significantly higher APACHE (Acute Physiology and Chronic Health Evaluation) score (43±18 vs 56±22, respectively; P <.0001), lower MAP (56±16 vs 49±17; P <.0001), and used more vasopressors (34% vs 45%; P <.0001). In the 554 patients without shock, there was no difference between those with ARDS vs without ARDS in terms of the NFB (-704 mL [95% CI, -1592 to 184 mL] vs 236 mL [95% CI -192 to 664 mL], respectively; P =.06). Comparatively, in the 2816 patients with shock, those with ARDS had higher NFB (3281 mL [95% CI, 2866-3695 mL] vs 1165 mL [95% CI, 929-1401 mL; P <.0001).
A linear regression analysis adjusted for age, sex, APACHE score, maximum lactate, minimum MAP, and maximum creatinine found that NFB attributable to ARDS was not significant for patients without shock (-788 mL; 95% CI, -1814 to 237 mL; P =.13). In this adjusted analysis, however, the NFB attributable to ARDS was significantly higher for patients with shock (990 mL; 95% CI, 564-1416 mL; P <.001). The researchers found a 5% increased odds for in-hospital mortality for each liter of fluid in patients with ARDS (adjusted odds ratio, 1.05; 95% CI, 1.03-1.08; P <.001). For each liter of fluid in patients with ARDS, there was also an increase in days of ventilation by 0.41 (95% CI, 0.21-0.61; P <.001).
According to the investigators, additional research “should evaluate the sequelae of this practice pattern as it may represent a target to improve outcomes.”
Aboodi MS, Chen J, Dieiev V, Hope AA, Gong MN. Fluid balance and mortality in ARDS and non-ARDS patients with and without shock: after FACTT, is it time for another trial? Am J Repir Crit Care Med. 2020;201:A1135.