Fluid management in critically ill patients: the role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance

Abstract

INTRODUCTION: Capillary leak in critically ill patients leads to interstitial edema. Fluid overload is independently associated with poor prognosis. Bedside measurement of intra-abdominal pressure (IAP), extravascular lung water index (EVLWI), fluid balance, and capillary leak index (CLI) may provide a valuable prognostic tool in mechanically ventilated patients. METHODS: We performed an observational study of 123 mechanically ventilated patients with extended hemodynamic monitoring, analyzing process-of-care variables for the first week of ICU admission. The primary outcome parameter was 28-day mortality. ΔmaxEVLWI indicated the maximum difference between EVLWI measurements during ICU stay. Patients with a ΔmaxEVLWI <-2 mL/kg were called 'responders'. CLI was defined as C-reactive protein (milligrams per deciliter) over albumin (grams per liter) ratio and conservative late fluid management (CLFM) as even-to-negative fluid balance on at least two consecutive days. RESULTS: CLI had a biphasic course. ΔmaxEVLWI was lower if CLFM was achieved and in survivors (-2.4 ± 4.8 vs 1.0 ± 5.5 mL/kg, p = 0.001; -3.3 ± 3.8 vs 2.5 ± 5.3 mL/kg, p = 0.001, respectively). No CLFM achievement was associated with increased CLI and IAPmean on day 3 and higher risk to be nonresponder (odds ratio (OR) 2.76, p = 0.046; OR 1.28, p = 0.011; OR 5.52, p = 0.001, respectively). Responders had more ventilator-free days during the first week (2.5 ± 2.3 vs 1.5 ± 2.3, p = 0.023). Not achieving CLFM and being nonresponder were strong independent predictors of mortality (OR 9.34, p = 0.001 and OR 7.14, p = 0.001, respectively). CONCLUSION: There seems to be an important correlation between CLI, EVLWI kinetics, IAP, and fluid balance in mechanically ventilated patients, associated with organ dysfunction and poor prognosis. In this context, we introduce the global increased permeability syndrome.

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References 45

1. 1.

   Bone RC Immunologic dissonance: a continuing evolution in our understanding of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS)Annals of internal medicine1996 1258680687

   Not in our library10.7326/0003-4819-125-8-199610150-00009

2. 2.

   Elbers PW Ince C Mechanisms of critical illness - classifying microcirculatory flow abnormalities in distributive shockCritical care2006 104221

   Not in our library10.1186/cc4969

3. 3.

   Rivers E Nguyen B Havstad S Ressler J Muzzin A Knoblich B Peterson E Tomlanovich M Early goal-directed therapy in the treatment of severe sepsis and septic shockThe New England journal of medicine2001 3451913681377

   Not in our library10.1056/nejmoa010307

4. 4.

   Guyton AC Interstitial fluid pressure. II. Pressure-volume curves of interstitial spaceCirculation research1965 16452460

   Not in our library10.1161/01.res.16.5.452

5. 5.

   Staub NC The pathogenesis of pulmonary edemaProgress in cardiovascular diseases1980 2315380

   Not in our library10.1016/0033-0620(80)90005-5

6. 6.

   Humphrey H Hall J Sznajder I Silverstein M Wood L Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressureChest1990 97511761180

   Not in our library10.1378/chest.97.5.1176

7. 7.

   Lowell JA Schifferdecker C Driscoll DF Benotti PN Bistrian BR Postoperative fluid overload: not a benign problemCritical care medicine1990 187728733

   Not in our library10.1097/00003246-199007000-00010

8. 8.

   Alsous F Khamiees M DeGirolamo A Amoateng-Adjepong Y Manthous CA Negative fluid balance predicts survival in patients with septic shock: a retrospective pilot studyChest2000 117617491754

   Not in our library10.1378/chest.117.6.1749

9. 9.

   Vincent JL Sakr Y Sprung CL Ranieri VM Reinhart K Gerlach H Moreno R Carlet J Le Gall JR Payen D Sepsis in European intensive care units: results of the SOAP studyCritical care medicine2006 342344353

   Not in our library10.1097/01.ccm.0000194725.48928.3a

10. 10.

    Brandstrup B Tonnesen H Beier-Holgersen R Hjortso E Ording H Lindorff-Larsen K Rasmussen MS Lanng C Wallin L Iversen LH Gramkow CS Okholm M Blemmer T Svendsen PE Rottensten HH Thage B Riis J Jeppesen IS Teilum D Christensen AM Graungaard B Pott F Danish Study Group on Perioperative Fluid TherapyEffects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trialAnnals of surgery2003 2385641648

    Not in our library10.1097/01.sla.0000094387.50865.23

11. 11.

    Schuller D Mitchell JP Calandrino FS Schuster DP Fluid balance during pulmonary edema. Is fluid gain a marker or a cause of poor outcome?Chest1991 100410681075

    Not in our library10.1378/chest.100.4.1068

12. 12.

    Murphy CV Schramm GE Doherty JA Reichley RM Gajic O Afessa B Micek ST Kollef MH The importance of fluid management in acute lung injury secondary to septic shockChest2009 1361102109

    Not in our library10.1378/chest.08-2706

13. 13.

    Sakr Y Vincent JL Reinhart K Groeneveld J Michalopoulos A Sprung CL Artigas A Ranieri VM High tidal volume and positive fluid balance are associated with worse outcome in acute lung injuryChest2005 128530983108

    Not in our library10.1378/chest.128.5.3098

14. 14.

    Prowle JR Echeverri JE Ligabo EV Ronco C Bellomo R Fluid balance and acute kidney injuryNature reviews2010 62107115

    Not in our library10.1038/nrneph.2009.213

15. 15.

    Malbrain ML Cheatham ML Kirkpatrick A Sugrue M Parr M De Waele J Balogh Z Leppaniemi A Olvera C Ivatury R D'Amours S Wendon J Hillman K Johansson K Kolkman K Wilmer A Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. DefinitionsIntensive care medicine2006 321117221732

    Not in our library10.1007/s00134-006-0349-5

16. 16.

    Wiedemann HP Wheeler AP Bernard GR Thompson BT Hayden D deBoisblanc B Connors AF Jr Hite RD Harabin AL Comparison of two fluid-management strategies in acute lung injuryThe New England journal of medicine2006 3542425642575

    Not in our library10.1056/nejmoa062200

17. 17.

    Schrier RW Wang W Acute renal failure and sepsisThe New England journal of medicine2004 3512159169

    Not in our library10.1056/nejmra032401

18. 18.

    Sakka SG Ruhl CC Pfeiffer UJ Beale R McLuckie A Reinhart K Meier-Hellmann A Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilutionIntensive care medicine2000 262180187

    Not in our library10.1007/s001340050043

19. 19.

    Fernandez-Mondejar E Guerrero-Lopez F Colmenero M How important is the measurement of extravascular lung water?Current opinion in critical care2007 1317983

    Not in our library10.1097/mcc.0b013e328011459b

20. 20.

    Berkowitz DM Danai PA Eaton S Moss M Martin GS Accurate characterization of extravascular lung water in acute respiratory distress syndromeCritical care medicine2008 36618031809

    Not in our library10.1097/ccm.0b013e3181743eeb

21. 21.

    Monnet X Anguel N Osman D Hamzaoui O Richard C Teboul JL Assessing pulmonary permeability by transpulmonary thermodilution allows differentiation of hydrostatic pulmonary edema from ALI/ARDSIntensive care medicine2007 333448453

    Not in our library10.1007/s00134-006-0498-6

22. 22.

    Kuzkov VV Kirov MY Sovershaev MA Kuklin VN Suborov EV Waerhaug K Bjertnaes LJ Extravascular lung water determined with single transpulmonary thermodilution correlates with the severity of sepsis-induced acute lung injuryCritical care medicine2006 34616471653

    Not in our library10.1097/01.ccm.0000218817.24208.2e

23. 23.

    Phillips CR Chesnutt MS Smith SM Extravascular lung water in sepsis-associated acute respiratory distress syndrome: indexing with predicted body weight improves correlation with severity of illness and survivalCritical care medicine2008 3616973

    Not in our library10.1097/01.ccm.0000295314.01232.be

24. 24.

    Bernard GR Artigas A Brigham KL Carlet J Falke K Hudson L Lamy M Legall JR Morris A Spragg R The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordinationAmerican journal of respiratory and critical care medicine1994 1493 Pt 1818824

    Not in our library10.1164/ajrccm.149.3.7509706

25. 25.

    Malbrain ML Debaveye Y De Coninck J Delmarcelle D Capillary leakage index as outcome predictor?Intensive Care Med2001 27S229(abstract)

    Not in our library

26. 26.

    Vincent JL de Mendonca A Cantraine F Moreno R Takala J Suter PM Sprung CL Colardyn F Blecher S Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care MedicineCritical care medicine1998 261117931800

    Not in our library10.1097/00003246-199811000-00016

27. 27.

    Le Gall JR Lemeshow S Saulnier F A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter studyJama1993 2702429572963

    Not in our library10.1001/jama.270.24.2957

28. 28.

    Knaus WA Draper EA Wagner DP Zimmerman JE APACHE II: a severity of disease classification systemCritical care medicine1985 1310818829

    Not in our library

29. 29.

    Malbrain ML Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisalIntensive care medicine2004 303357371

    Not in our library10.1007/s00134-003-2107-2

30. 30.

    Cuthbertson DP Post-shock metabolic responseLancet1942 i433447

    Not in our library

31. 31.

    Fleck A Raines G Hawker F Trotter J Wallace PI Ledingham IM Calman KC Increased vascular permeability: a major cause of hypoalbuminaemia in disease and injuryLancet1985 18432781784

    Not in our library10.1016/s0140-6736(85)91447-3

32. 32.

    Schrier RW Body fluid volume regulation in health and disease: a unifying hypothesisAnnals of internal medicine1990 1132155159

    Not in our library10.7326/0003-4819-113-2-155

33. 33.

    Bagshaw SM Brophy PD Cruz D Ronco C Fluid balance as a biomarker: impact of fluid overload on outcome in critically ill patients with acute kidney injuryCritical care2008 124169

    Not in our library10.1186/cc6948

34. 34.

    Pepys MB Hirschfield GM C-reactive protein: a critical updateThe Journal of clinical investigation2003 1111218051812

    Not in our library10.1172/jci18921

35. 35.

    Simmons RS Berdine GG Seidenfeld JJ Prihoda TJ Harris GD Smith JD Gilbert TJ Mota E Johanson WG Jr Fluid balance and the adult respiratory distress syndromeThe American review of respiratory disease1987 1354924929

    Not in our library10.1164/arrd.1987.135.4.924

36. 36.

    Rosenberg AL Dechert RE Park PK Bartlett RH 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 cohortJournal of intensive care medicine2009 2413546

    Not in our library10.1177/0885066608329850

37. 37.

    Rivers EP Fluid-management strategies in acute lung injury - liberal, conservative, or both?The New England journal of medicine2006 3542425982600

    Not in our library10.1056/nejme068105

38. 38.

    Boerma EC van der Voort PH Spronk PE Ince C Relationship between sublingual and intestinal microcirculatory perfusion in patients with abdominal sepsisCritical care medicine2007 35410551060

    Not in our library10.1097/01.ccm.0000259527.89927.f9

39. 39.

    Malbrain ML Wilmer A The polycompartment syndrome: towards an understanding of the interactions between different compartments!Intensive care medicine2007 331118691872

    Not in our library10.1007/s00134-007-0843-4

40. 40.

    Malbrain ML Chiumello D Pelosi P Bihari D Innes R Ranieri VM Del Turco M Wilmer A Brienza N Malcangi V Cohen J Japiassu A De Keulenaer BL Daelemans R Jacquet L Laterre PF Frank G de Souza P Cesana B Gattinoni L Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological studyCritical care medicine2005 332315322

    Not in our library10.1097/01.ccm.0000153408.09806.1b

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