Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients - insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis.

Sanchit Ahuja, Harm-Jan de Grooth, Frederique Paulus, Fleur L van der Ven, Ary Serpa Neto, Marcus J Schultz, Pieter R Tuinman

Journal: Critical care (London, England) 2022;26(1):157

PMID: 35650616

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Abstract

BACKGROUND

Increasing evidence indicates the potential benefits of restricted fluid management in critically ill patients. Evidence lacks on the optimal fluid management strategy for invasively ventilated COVID-19 patients. We hypothesized that the cumulative fluid balance would affect the successful liberation of invasive ventilation in COVID-19 patients with acute respiratory distress syndrome (ARDS).

METHODS

We analyzed data from the multicenter observational 'PRactice of VENTilation in COVID-19 patients' study. Patients with confirmed COVID-19 and ARDS who required invasive ventilation during the first 3 months of the international outbreak (March 1, 2020, to June 2020) across 22 hospitals in the Netherlands were included. The primary outcome was successful liberation of invasive ventilation, modeled as a function of day 3 cumulative fluid balance using Cox proportional hazards models, using the crude and the adjusted association. Sensitivity analyses without missing data and modeling ARDS severity were performed.

RESULTS

Among 650 patients, three groups were identified. Patients in the higher, intermediate, and lower groups had a median cumulative fluid balance of 1.98 L (1.27-7.72 L), 0.78 L (0.26-1.27 L), and - 0.35 L (- 6.52-0.26 L), respectively. Higher day 3 cumulative fluid balance was significantly associated with a lower probability of successful ventilation liberation (adjusted hazard ratio 0.86, 95% CI 0.77-0.95, P = 0.0047). Sensitivity analyses showed similar results.

CONCLUSIONS

In a cohort of invasively ventilated patients with COVID-19 and ARDS, a higher cumulative fluid balance was associated with a longer ventilation duration, indicating that restricted fluid management in these patients may be beneficial. Trial registration Clinicaltrials.gov ( NCT04346342 ); Date of registration: April 15, 2020.

Address: Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, Detroit, MI, USA.; Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA.; Department of Intensive Care, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands.; Department of Intensive Care, C3-415, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.; ACHIEVE, Faculty of Health, Centre of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.; Department of Critical Care Medicine, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia.; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.; Department of Intensive Care, C3-415, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. [email protected].; Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand. [email protected].; Nuffield Department of Medicine, University of Oxford, Oxford, UK. [email protected].

DOI: 10.1186/s13054-022-04023-y

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MeSH Terms: COVID-19, Cohort Studies, Humans, Noninvasive Ventilation, Respiration, Respiratory Distress Syndrome, Water-Electrolyte Balance