June 15, 2006
Comparison of Two Fluid-Management Strategies in Acute Lung Injury.
What was the research question?
Is conservative fluid strategy associated with improved mortality compared to liberal fluid strategy in patients with ALI/ARDS?
How did they do it?
In a randomized study in 20 North American centers.
Included 1000 patients with early ALI/ARDS within 48 hours.
Randomized to receive a conservative fluid strategy (net even balance) or a liberal strategy of fluid management (positive fluid balance).
The primary end point was death at 60 days.
Secondary end points included the number of ventilator-free days and organ-failure–free days and measures of lung physiology.
What did they find?
· 60-day mortality was not different between the two groups (25.5% in the conservative-strategy group and 28.4% percent in the liberal-strategy group (P=0.30).
· Conservative management had more ventilator-free days at day 28
· The mean (±SE) cumulative fluid balance during the first seven days was –136±491 ml in the conservative-strategy group and 6992±502 ml in the liberal-strategy group (P<0.001).
· As compared with the liberal strategy, the conservative strategy improved the oxygenation index and the lung injury score and increased the number of ventilator-free days (14.6 vs. 12.1, P<0.001) and days not spent in the intensive care unit (13.4 vs. 11.2, P<0.001) during the first 28 days but did not increase the incidence or prevalence of shock during the study or the use of dialysis during the first 60 days (10 percent vs. 14 percent, P=0.06).
What are the limitations of the study?
· The trial was stopped early due to concern of harm
What does it mean?
· Conservative fluid strategy did not improved 60-day mortality but improved lung function and shortened the duration of mechanical ventilation and intensive care without increasing nonpulmonary-organ failures.
· These results support the use of a conservative strategy of fluid management in patients with acute lung injury