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.