Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Association between Cumulative Fluid Balance and Outcomes in Acute Respiratory Distress Syndrome Patients Treated with Extracorporeal Membrane Oxygenation

  • Lee, Jun Hee (Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine) ;
  • Won, Jong Yun (Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine) ;
  • Kim, Ji Eon (Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine) ;
  • Kim, Hee Jung (Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine) ;
  • Jung, Jae Seung (Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine) ;
  • Son, Ho Sung (Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Korea University College of Medicine)
  • Received : 2020.09.24
  • Accepted : 2020.11.10
  • Published : 2021.02.05
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Abstract

Background: Extracorporeal membrane oxygenation (ECMO) has become increasingly accepted as a life-saving procedure for patients with severe acute respiratory distress syndrome (ARDS). This study investigated the relationship between cumulative fluid balance (CFB) and outcomes in adult ARDS patients treated with ECMO. Methods: We retrospectively analyzed the data of adult ARDS patients who received ECMO between December 2009 and December 2019 at Korea University Anam Hospital. CFB was calculated during the first 7 days after ECMO initiation. The primary endpoint was 28-day mortality. Results: The 74 patients were divided into survivor (n=33) and non-survivor (n=41) groups based on 28-day survival. Non-survivors showed a significantly higher CFB at 1-7 days (p<0.05). Cox multivariable proportional hazard regression revealed a relationship between CFB on day 3 and 28-day mortality (hazard ratio, 3.366; 95% confidence interval, 1.528-7.417; p=0.003). Conclusion: In adult ARDS patients treated with ECMO, a higher positive CFB on day 3 was associated with increased 28-day mortality. Based on our findings, we suggest a restrictive fluid strategy in ARDS patients treated with ECMO. CFB may be a useful predictor of survival in ARDS patients treated with ECMO.

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References

  1. Makdisi G, Wang IW. Extra Corporeal Membrane Oxygenation (ECMO) review of a lifesaving technology. J Thorac Dis 2015;7: E166-76.
  2. Sorokin V, MacLaren G, Vidanapathirana PC, Delnoij T, Lorusso R. Choosing the appropriate configuration and cannulation strategies for extracorporeal membrane oxygenation: the potential dynamic process of organ support and importance of hybrid modes. Eur J Heart Fail 2017;19 Suppl 2:75-83. https://doi.org/10.1002/ejhf.849
  3. Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 2016;315:788-800. https://doi.org/10.1001/jama.2016.0291
  4. Diamond M, Peniston Feliciano HL, Sanghavi, D, Mahapatra S. Acute respiratory distress syndrome. Treasure Island (FL): StatPearls Publishing; 2020.
  5. Zambon M, Vincent JL. Mortality rates for patients with acute lung injury/ARDS have decreased over time. Chest 2008;133:1120-7. https://doi.org/10.1378/chest.07-2134
  6. Davidson TA, Caldwell ES, Curtis JR, Hudson LD, Steinberg KP. Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients. JAMA 1999;281: 354-60. https://doi.org/10.1001/jama.281.4.354
  7. Erickson SE, Martin GS, Davis JL, Matthay MA, Eisner MD; NIH NHLBI ARDS Network. Recent trends in acute lung injury mortality: 1996-2005. Crit Care Med 2009;37:1574-9. https://doi.org/10.1097/CCM.0b013e31819fefdf
  8. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA 2012;307:2526-33.
  9. Thompson BT, Chambers RC, Liu KD. Acute respiratory distress syndrome. N Engl J Med 2017;377:562-72. https://doi.org/10.1056/NEJMra1608077
  10. Villar J, Perez-Mendez L, Blanco J, et al. A universal definition of ARDS: the PaO2/FiO2 ratio under a standard ventilatory setting: a prospective, multicenter validation study. Intensive Care Med 2013; 39:583-92. https://doi.org/10.1007/s00134-012-2803-x
  11. Hardin CC, Hibbert K. ECMO for severe ARDS. N Engl J Med 2018;378:2032-4. https://doi.org/10.1056/NEJMe1802676
  12. Ma DS, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Outcomes of venovenous extracorporeal membrane oxygenation support for acute respiratory distress syndrome in adults. Korean J Thorac Cardiovasc Surg 2012;45:91-4. https://doi.org/10.5090/kjtcs.2012.45.2.91
  13. Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators, Davies A, Jones D, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA 2009;302:1888-95. https://doi.org/10.1001/jama.2009.1535
  14. Peek GJ, Clemens F, Elbourne D, et al. CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure. BMC Health Serv Res 2006;6:163. https://doi.org/10.1186/1472-6963-6-163
  15. Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med 2018;378:1965-75. https://doi.org/10.1056/NEJMoa1800385
  16. Van Mourik N, Metske HA, Hofstra JJ, et al. Cumulative fluid balance predicts mortality and increases time on mechanical ventilation in ARDS patients: an observational cohort study. PLoS One 2019;14:e0224563. https://doi.org/10.1371/journal.pone.0224563
  17. Rosenberg AL, Dechert RE, Park PK, Bartlett RH; NIH NHLBI ARDS Network. 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 cohort. J Intensive Care Med 2009;24:35-46. https://doi.org/10.1177/0885066608329850
  18. Zinter MS, Spicer AC, Liu KD, et al. Positive cumulative fluid balance is associated with mortality in pediatric acute respiratory distress syndrome in the setting of acute kidney injury. Pediatr Crit Care Med 2019;20:323-31. https://doi.org/10.1097/pcc.0000000000001845
  19. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006;354:2564-75. https://doi.org/10.1056/NEJMoa062200
  20. Finfer S, Liu B, Taylor C, et al. Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units. Crit Care 2010;14:R185. https://doi.org/10.1186/cc9293
  21. Shen Y, Huang X, Zhang W. Association between fluid intake and mortality in critically ill patients with negative fluid balance: a retrospective cohort study. Crit Care 2017;21:104. https://doi.org/10.1186/s13054-017-1692-3
  22. Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med 2011;39:259-65. https://doi.org/10.1097/CCM.0b013e3181feeb15
  23. Malbrain ML, Marik PE, Witters I, et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther 2014;46:361-80. https://doi.org/10.5603/AIT.2014.0060
  24. Kim H, Paek JH, Song JH, et al. Permissive fluid volume in adult patients undergoing extracorporeal membrane oxygenation treatment. Crit Care 2018;22:270. https://doi.org/10.1186/s13054-018-2211-x
  25. Schmidt M, Bailey M, Kelly J, et al. Impact of fluid balance on outcome of adult patients treated with extracorporeal membrane oxygenation. Intensive Care Med 2014;40:1256-66. https://doi.org/10.1007/s00134-014-3360-2
  26. Roch A, Guervilly C, Papazian L. Fluid management in acute lung injury and ARDS. Ann Intensive Care 2011;1:16. https://doi.org/10.1186/2110-5820-1-16
  27. Chen H, Yu RG, Yin NN, Zhou JX. Combination of extracorporeal membrane oxygenation and continuous renal replacement therapy in critically ill patients: a systematic review. Crit Care 2014;18:675. https://doi.org/10.1186/s13054-014-0675-x
  28. Vlaar AP, Binnekade JM, Prins D, et al. Risk factors and outcome of transfusion-related acute lung injury in the critically ill: a nested case-control study. Crit Care Med 2010;38:771-8. https://doi.org/10.1097/CCM.0b013e3181cc4d4b
  29. Murphy CV, Schramm GE, Doherty JA, et al. The importance of fluid management in acute lung injury secondary to septic shock. Chest 2009;136:102-9. https://doi.org/10.1378/chest.08-2706
  30. Gong MN, Thompson BT, Williams P, Pothier L, Boyce PD, Christiani DC. Clinical predictors of and mortality in acute respiratory distress syndrome: potential role of red cell transfusion. Crit Care Med 2005;33:1191-8. https://doi.org/10.1097/01.CCM.0000165566.82925.14