Review of A Large Clinical Series: Association of Cumulative Fluid Balance on Outcome in Acute Lung Injury: A Retrospective Review of the ARDSnet Tidal Volume Study Cohort
OBJECTIVE: To evaluate the independent influence of fluid balance on outcomes for patients with acute lung injury. DESIGN: Secondary analysis of a prospective cohort study conducted between March 1996 and March 1999. SETTING: The study involved 10 academic clinical centers (with 24 hospitals and 75 Intensive Care Units). PATIENTS: All patients for whom fluid balance data existed (844) from the 902 patients enrolled in the National Heart Lung Blood Institute's ARDS Network ventilator-tidal volume trial. INTERVENTIONS: The study had no interventions. MEASUREMENTS/RESULTS: On the first day of study enrollment, 683 patients were, on average, more than 3.5 L in positive fluid balance compared to 161 patients in negative fluid balance (P < .001). Cumulative negative fluid balance on day 4 of the study was associated with an independently lower hospital mortality (OR, 0.50; 95% CI, 0.28-0.89; P < .001) more ventilator and intensive care unit-free days. CONCLUSIONS: Negative cumulative fluid balance at day 4 of acute lung injury is associated with significantly lower mortality, independent of other measures of severity of illness.