Fluid restriction versus conventional fluid administration in acute lung injury patients (Comparative study between different strategies of fluid administration in acute lung injury patients)

Abstract

Abstract Background Acute lung injury and ARDS are major causes of morbidity and mortality all over the world. Major steps of understanding the pathophysiology, causes, diagnosis and treatment of this syndrome were taken in last twenty year. Diagnosis of this condition remains underestimated by physicians particularly mild form of this syndrome specially in developing world in which presence of investigations and well trained physicians is not adequate. Objective To compare between the outcomes of fluid administration strategies in the form of restricted or conventional fluid administration that affect oxygenation, weaning of mechanical ventilation and free days of icu admission in acute lung injury patients and its severe form ARDS. To detect the optimal strategy of fluid administration which decrease morbidity and mortality. Patients and Methods Type of Study: Prospective study. Study Setting: The study will be conducted in the ICU units at Ain-Shams University Hospitals and Ahmed Maher Teaching Hospital. Study Period: Four months from date of approval of the protocol. 90 adult patients- divided into three groups each group include 30 patients- (fulfilling inclusion criteria) admitted in the ICU units at Ain Shams University Hospitals and Ahmed Maher Teaching Hospital were included. Results Based on more than one point of view; underlying cause of ARDS palys major role in predicting these unpredictable results of this study in haemodynamically unstable patients. There are many factors, rather than hypoxemia, that affect organ outcomes (including respiratory system itself) in haemodynamically unstable patients which may caused by septic shock and other types of shock. Conclusion This small trial evoked new questions more than answering traditional ones about fluid management of acute lung injury and ARDS. Firstly; the accurate method to assess and guide fluid therapy in ARDS should be on top of searching priorities. Although using central venous pressure to guide fluid therapy could theoretically results in outcome improvement, but according to its many limitations and poor relation to volume status, its using in that issue is questionable. Secondly; establishing one fluid management strategy to all patients with ARDS seems to be not accurate. Unpredictable results on outcomes in ARDS patients receiving fluids particularly in those were haemodynamically unstable drive us to seek for new classification of ARDS patients based on underlying cause, haemodynamic stability and other elements that responsible for organ failure rather than volume status. However; this small trial suggests conservative fluid strategy in acute lung injury patients which are haemodynamically stable. And using of both conservative and liberal fluid administration strategies wisely in those patients which are haemodynamically unstable to reach the optimal intravascular volume– pressure with the best risk–benefit ratio.