Early restrictive fluid resuscitation has no clinical advantage in experimental severe pediatric acute respiratory distress syndrome
| Autor: | Reinout A. Bem, Job B. M. van Woensel, Joris Lemson, Marloes M. Ijland, Lex M. van Loon, Sarah A. Ingelse |
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| Přispěvatelé: | Paediatric Intensive Care, AII - Inflammatory diseases, AR&D - Amsterdam Reproduction & Development |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
Resuscitation ARDS medicine.medical_specialty Time Factors Physiology Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] Acute respiratory distress Restrictive fluid strategy 03 medical and health sciences 0302 clinical medicine Physiology (medical) Medicine Animals 030212 general & internal medicine Intensive care medicine Respiratory Distress Syndrome Fluids Sheep business.industry Hemodynamics 030208 emergency & critical care medicine Cell Biology Pediatric animal model medicine.disease Respiration Artificial Circulatory system Extravascular Lung Water Fluid overload Fluid Therapy business |
| Zdroj: | American Journal of Physiology : Lung Cellular and Molecular Physiology, 320, 6, pp. L1126-l1136 American journal of physiology. Lung cellular and molecular physiology, 320(6), L1126-L1136. American Physiological Society American Journal of Physiology : Lung Cellular and Molecular Physiology, 320, L1126-l1136 |
| ISSN: | 1040-0605 |
| Popis: | Contains fulltext : 245043.pdf (Publisher’s version ) (Closed access) Intravenous fluids are widely used to treat circulatory deterioration in pediatric acute respiratory distress syndrome (PARDS). However, the accumulation of fluids in the first days of PARDS is associated with adverse outcome. As such, early fluid restriction may prove beneficial, yet the effects of such a fluid strategy on the cardiopulmonary physiology in PARDS are unclear. In this study, we compared the effect of a restrictive with a liberal fluid strategy on a hemodynamic response and the formation of pulmonary edema in an animal model of PARDS. Sixteen mechanically ventilated lambs (2-6 wk) received oleic acid infusion to induce PARDS and were randomized to a restrictive or liberal fluid strategy during a 6-h period of mechanical ventilation. Transpulmonary thermodilution determined extravascular lung water (EVLW) and cardiac output (CO). Postmortem lung wet-to-dry weight ratios were obtained by gravimetry. Restricting fluids significantly reduced fluid intake but increased the use of vasopressors among animals with PARDS. Arterial blood pressure was similar between groups, yet CO declined significantly in animals receiving restrictive fluids (P = 0.005). There was no difference in EVLW over time (P = 0.111) and lung wet-to-dry weight ratio [6.1, interquartile range (IQR) = 6.0-7.3 vs. 7.1, IQR = 6.6-9.4, restrictive vs. liberal, P = 0.725] between fluid strategies. Both fluid strategies stabilized blood pressure in this model, yet early fluid restriction abated CO. Early fluid restriction did not limit the formation of pulmonary edema; therefore, this study suggests that in the early phase of PARDS, a restrictive fluid strategy is not beneficial in terms of immediate cardiopulmonary effects. |
| Databáze: | OpenAIRE |
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