We have located links that may give you full text access.
Early Restrictive Fluid Resuscitation has no Clinical Advantage in Experimental Severe Pediatric Acute Respiratory Distress Syndrome.
BACKGROUND: 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 cardio-pulmonary physiology in PARDS is unclear. In this study, we compared the effect of a restrictive to a liberal fluid strategy on hemodynamic response and the formation of pulmonary edema in an animal model of PARDS.
METHODS: Sixteen mechanically ventilated lambs (2-6 weeks) received oleic acid infusion to induce PARDS and were randomized to a restrictive or liberal fluid strategy during a 6-hour period of mechanical ventilation. Transpulmonary thermodilution determined extravascular lung water (EVLW) and cardiac output (CO) Post-mortem lung wet-to-dry weight ratios were obtained by gravimetry.
RESULTS: Restricting fluids significantly reduced fluid intake, but increased 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 IQR 6.0-7.3 vs. 7.1 IQR 6.6-9.4 restrictive vs. liberal, p=0.725) between fluid strategies.
CONCLUSIONS: 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 cardio-pulmonary effects.
METHODS: Sixteen mechanically ventilated lambs (2-6 weeks) received oleic acid infusion to induce PARDS and were randomized to a restrictive or liberal fluid strategy during a 6-hour period of mechanical ventilation. Transpulmonary thermodilution determined extravascular lung water (EVLW) and cardiac output (CO) Post-mortem lung wet-to-dry weight ratios were obtained by gravimetry.
RESULTS: Restricting fluids significantly reduced fluid intake, but increased 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 IQR 6.0-7.3 vs. 7.1 IQR 6.6-9.4 restrictive vs. liberal, p=0.725) between fluid strategies.
CONCLUSIONS: 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 cardio-pulmonary effects.
Full text links
Related Resources
Trending Papers
Obesity pharmacotherapy in older adults: a narrative review of evidence.International Journal of Obesity 2024 May 7
Haemodynamic monitoring during noncardiac surgery: past, present, and future.Journal of Clinical Monitoring and Computing 2024 April 31
SGLT2 Inhibitors in Kidney Diseases-A Narrative Review.International Journal of Molecular Sciences 2024 May 2
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app