Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients — insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis

Sanchit Ahuja,A Artigas,F A Bertens,D W De Lange,D C J J Bergmans,D Ivanov,H S Franke,S T Van Der Heide,H J F T Wesselink,Fleur L Van Der Ven,D I Van Den Bersselaar,C J Pennartz,H De Bruin,M M De Boer,C K Algoe,Stephan J.p Hiel ,Pablo Van De Berg ,Marisa Onrust ,Bas Van Wijk ,Olaf L Cremer ,Thijs C.d Rettig ,Matty Koopmans ,R Van Der Horst,O Baur ,Rombout B E Van Amstel ,Anissa M Tsonas ,Felicia L Veen-Schra ,Laura A Hagens ,Hermien H Van Der Wier-Lubbers ,Jasper J Haringman ,Wing Yi Wong ,Patricia Van Velzen ,Peter E Spronk ,Liselotte Hol ,Rogier M Determann ,Mart J De Graaff ,Lars I Veldhuis ,Ilse M Purmer ,A.w.m.m Koopman-Van Gemert ,Marcus W Hollmann ,Aart C Strang ,Pieter R Tuinman,Marga E Hoogendoorn ,Eline Kho ,Sunny G L H Nijbroek ,Michael Kuiper ,Michela Botta ,A.e Van Den Berg ,Nanon F.l Heijnen ,Laura A Buiteman–Kruizinga ,Lieuwe Bos ,Nicole P Juffermans ,Michiel T.u Schuijt ,Ward H Van Der Ven ,Anna Geke Algera ,Leonoor S Boers ,Eline S De Klerk ,Michal S Galek-Aldridge ,Alexander J G H Bindels ,Ary Serpa Neto,Peter H J Van Der Voort ,Peter Van De Vliet ,Marry R Smit ,Jesse P Van Akkeren ,Harm-Jan De Grooth,Janesh Pillay ,Tineke Winters ,Christel M A Valk ,Jan Paul Roozeman ,Caro L Bruna ,Niels Van Mourik ,Marcus J Schultz,Evelien Oostdijk ,L Van Welie,Mengalvio Sleeswijk ,Sylvia Den Boer ,E L K Ie,Pim L.j Van Der Heiden ,Sanne De Bruin ,Luigi Pisani ,Margriet Bogerd ,Frederique Paulus,Janneke Horn ,Lotte L Hoeijmakers ,Willem Dieperink ,Alexander P.j Vlaar ,S Kucukcelebi,Willemke Stilma ,Jennifer S Breel ,Dave A Dongelmans ,Arthur R.h Van Zanten

doi:10.1186/s13054-022-04023-y

Abstract

BackgroundIncreasing evidence indicates the potential benefits of restricted fluid management in critically ill patients. Evidence lacks on the optimal fluid management strategy for invasively ventilated COVID-19 patients. We hypothesized that the cumulative fluid balance would affect the successful liberation of invasive ventilation in COVID-19 patients with acute respiratory distress syndrome (ARDS).MethodsWe analyzed data from the multicenter observational ‘PRactice of VENTilation in COVID-19 patients’ study. Patients with confirmed COVID-19 and ARDS who required invasive ventilation during the first 3 months of the international outbreak (March 1, 2020, to June 2020) across 22 hospitals in the Netherlands were included. The primary outcome was successful liberation of invasive ventilation, modeled as a function of day 3 cumulative fluid balance using Cox proportional hazards models, using the crude and the adjusted association. Sensitivity analyses without missing data and modeling ARDS severity were performed.ResultsAmong 650 patients, three groups were identified. Patients in the higher, intermediate, and lower groups had a median cumulative fluid balance of 1.98 L (1.27–7.72 L), 0.78 L (0.26–1.27 L), and − 0.35 L (− 6.52–0.26 L), respectively. Higher day 3 cumulative fluid balance was significantly associated with a lower probability of successful ventilation liberation (adjusted hazard ratio 0.86, 95% CI 0.77–0.95, P = 0.0047). Sensitivity analyses showed similar results.ConclusionsIn a cohort of invasively ventilated patients with COVID-19 and ARDS, a higher cumulative fluid balance was associated with a longer ventilation duration, indicating that restricted fluid management in these patients may be beneficial.Trial registration Clinicaltrials.gov (NCT04346342); Date of registration: April 15, 2020.Graphical abstract

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