Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, Detroit, MI, USA.
Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA.
Crit Care. 2022 Jun 1;26(1):157. doi: 10.1186/s13054-022-04023-y.
Increasing 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).
We 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.
Among 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.
In 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.
越来越多的证据表明，限制液体管理对危重症患者可能有益。在接受有创机械通气的 COVID-19 患者中，关于最佳液体管理策略的证据尚缺乏。我们假设，累积液体平衡将影响急性呼吸窘迫综合征（ARDS）COVID-19 患者成功撤机。
我们分析了多中心观察性“COVID-19 患者通气实践”研究的数据。纳入荷兰 22 家医院在国际疫情爆发的前 3 个月（2020 年 3 月 1 日至 2020 年 6 月）期间接受有创机械通气且确诊 COVID-19 合并 ARDS 的患者。主要结局为有创机械通气成功撤机，采用 Cox 比例风险模型，以第 3 天累积液体平衡为函数进行建模，使用粗模型和调整模型进行关联分析。还进行了无缺失数据和 ARDS 严重程度建模的敏感性分析。
在 650 例患者中，确定了 3 组。高、中、低组患者的中位累积液体平衡分别为 1.98 L（1.27-7.72 L）、0.78 L（0.26-1.27 L）和-0.35 L（-6.52-0.26 L）。第 3 天较高的累积液体平衡与较低的成功撤机概率显著相关（调整后的危险比 0.86，95%CI 0.77-0.95，P=0.0047）。敏感性分析结果相似。
在接受有创机械通气的 COVID-19 和 ARDS 患者队列中，较高的累积液体平衡与较长的通气时间相关，表明对这些患者进行限制液体管理可能有益。
Clinicaltrials.gov（NCT04346342）；注册日期：2020 年 4 月 15 日。
