Radu F Neamu1, Greg S Martin. 1. Division of Pulmonary, Allergy and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Abstract
PURPOSE OF REVIEW: Fluid management is one of the most important measures shown to impact acute respiratory distress syndrome (ARDS) outcomes. This review summarizes the current strategies aimed at evaluating and modulating lung fluid balance. RECENT FINDINGS: Multiple recent studies have shown that a conservative fluid management in ARDS patients had beneficial effects on morbidity and mortality. These findings were replicated also in different patient populations assumed to have potential deleterious effects from this approach. So far, only one retrospective study raised the possibility of impaired cognitive function in ARDS patients managed with a conservative fluid strategy. Thermodilution methods and serum biomarkers can be used to monitor lung fluid balance and guide therapy. Recent evidence has indicated significant detrimental effects associated with beta-2 agonists use in ARDS, despite a putative beneficial role in the resolution of alveolar edema seen in preliminary studies. SUMMARY: Dynamic monitoring of lung fluid balance needs to be implemented to guide fluid therapy in ARDS patients. A conservative fluid strategy seems safe and yields overall good clinical outcomes, but its impact on cognitive function needs to be evaluated in further studies. The role of colloids and other pharmacological agents deserves further investigation.
PURPOSE OF REVIEW: Fluid management is one of the most important measures shown to impact acute respiratory distress syndrome (ARDS) outcomes. This review summarizes the current strategies aimed at evaluating and modulating lung fluid balance. RECENT FINDINGS: Multiple recent studies have shown that a conservative fluid management in ARDSpatients had beneficial effects on morbidity and mortality. These findings were replicated also in different patient populations assumed to have potential deleterious effects from this approach. So far, only one retrospective study raised the possibility of impaired cognitive function in ARDSpatients managed with a conservative fluid strategy. Thermodilution methods and serum biomarkers can be used to monitor lung fluid balance and guide therapy. Recent evidence has indicated significant detrimental effects associated with beta-2 agonists use in ARDS, despite a putative beneficial role in the resolution of alveolar edema seen in preliminary studies. SUMMARY: Dynamic monitoring of lung fluid balance needs to be implemented to guide fluid therapy in ARDSpatients. A conservative fluid strategy seems safe and yields overall good clinical outcomes, but its impact on cognitive function needs to be evaluated in further studies. The role of colloids and other pharmacological agents deserves further investigation.
Authors: Thomas S Metkus; Emmanouil Tampakakis; Christopher J Mullin; Brian A Houston; Todd M Kolb; Stephen C Mathai; Rachel Damico; Bradley A Maron; Paul M Hassoun; Roy G Brower; Ryan J Tedford Journal: Crit Care Med Date: 2017-03 Impact factor: 7.598
Authors: Mauricio Rojas; Nayra Cárdenes; Ergin Kocyildirim; John R Tedrow; Eder Cáceres; Robert Deans; Anthony Ting; Christian Bermúdez Journal: Stem Cell Res Ther Date: 2014-03-26 Impact factor: 6.832