Fluid Management in Patients with Acute Respiratory Distress Syndrome and Diabetes Mellitus: A propensity score matched analysis of the fluid and catheter treatment trial
| Autor: | Douglas Hayden, B. T. Thompson, Aditya Achanta |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male ARDS medicine.medical_specialty Catheters Observational Study Vascular permeability Conservative Treatment law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Treatment trial law Internal medicine Diabetes mellitus medicine Diabetes Mellitus Humans 030212 general & internal medicine Propensity Score Aged Respiratory Distress Syndrome business.industry General Medicine Middle Aged medicine.disease fluid and catheters treatment trial Catheter fluid management 030220 oncology & carcinogenesis Propensity score matching ComputingMethodologies_DOCUMENTANDTEXTPROCESSING Fluid Therapy Observational study Female business Research Article |
| Zdroj: | Medicine |
| ISSN: | 1536-5964 |
| Popis: | Supplemental Digital Content is available in the text Diabetes mellitus results in an attenuated inflammatory response, reduces pulmonary microvascular permeability, and may decrease the risk of developing acute respiratory distress syndrome (ARDS). Studies have shown that patients with ARDS are better managed by a conservative as compared to liberal fluid management strategy. However, it is not known if the same fluid management principles hold true for patients with comorbid diabetes mellitus and ARDS. As diabetes mellitus results in reduced pulmonary microvascular permeability and an attenuated inflammatory response, we hypothesize that in the setting of ARDS, diabetic patients will be able to tolerate a positive fluid balance better than patients without diabetes. The Fluid and Catheter Treatment Trial (FACTT) randomized patients with ARDS to conservative versus liberal fluid management strategies. In a secondary analysis of this trial, we calculated the interaction of diabetic status and differing fluid strategies on outcomes. Propensity score subclassification matching was used to control for the differing baseline characteristics between patients with and without diabetes. Nine hundred fifty-six patients were analyzed. In a propensity score matched analysis, the difference in the effect of a conservative as compared to liberal fluid management strategy on ventilator free days was 2.23 days (95% CI: −0.97 to 5.43 days) in diabetic patients, and 2.37 days (95% CI: −0.21 to 4.95 days) in non-diabetic patients. The difference in the effect of a conservative as compared to liberal fluid management on 60 day mortality was 2% (95% CI: −11.8% to 15.8%) in diabetic patients, and −7.9% (95% CI: −21.7% to 5.9%) in non-diabetic patients. When comparing a conservative fluid management strategy to a liberal fluid management strategy, diabetic patients with ARDS did not have a statistically significant difference in outcomes than non-diabetic patients. |
| Databáze: | OpenAIRE |
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