Optimizing Fluid Management Guided by Volumetric Parameters in Patients with Sepsis and ARDS

• Published in: International journal of molecular sciences 2023-05, Vol.24 (10), p.8768
• Main Authors: Fot, Evgeniia V, Khromacheva, Natalia O, Ushakov, Aleksei A, Smetkin, Aleksei A, Kuzkov, Vsevolod V, Kirov, Mikhail Y
• Format: Article
• Language: English
• Subjects: Acidosis; Acute respiratory distress syndrome; Alkalosis; Care and treatment; Creatinine; Dehydration; Diuretics; Electrolytes; Extravascular Lung Water; Fluid management; Fluid Therapy; Hemodynamics; Humans; Infection; Lung; Lungs; Metabolism; Oxygenation; Potassium; Respiratory Distress Syndrome - therapy; Sepsis; Sepsis - complications; Sepsis - therapy; Septic shock; Ultrafiltration; Ventilators
• ISSN: 1422-0067; 1661-6596; 1422-0067
• DOI: 10.3390/ijms24108768

We compared two de-escalation strategies guided by either extravascular lung water or global end-diastolic volume-oriented algorithms in patients with sepsis and ARDS. Sixty patients with sepsis and ARDS were randomized to receive de-escalation fluid therapy, guided either by the extravascular lung water index (EVLWI, = 30) or the global end-diastolic volume index (GEDVI, = 30). In cases of GEDVI > 650 mL/m or EVLWI > 10 mL/kg, diuretics and/or controlled ultrafiltration were administered to achieve the cumulative 48-h fluid balance in the range of 0 to -3000 mL. During 48 h of goal-directed de-escalation therapy, we observed a decrease in the SOFA score ( < 0.05). Extravascular lung water decreased only in the EVLWI-oriented group ( 0.001). In parallel, PaO /FiO increased by 30% in the EVLWI group and by 15% in the GEDVI group ( 0.05). The patients with direct ARDS demonstrated better responses to dehydration therapy concerning arterial oxygenation and lung fluid balance. In sepsis-induced ARDS, both fluid management strategies, based either on GEDVI or EVLWI, improved arterial oxygenation and attenuated organ dysfunction. The de-escalation therapy was more efficient for direct ARDS.