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Semin Respir Crit Care Med 2019; 40(01): 057-065
DOI: 10.1055/s-0039-1685206
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Fluid Management in Acute Respiratory Distress Syndrome

Jonathan D. Casey
1   Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
,
Matthew W. Semler
1   Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
,
Todd W. Rice
1   Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
› Author Affiliations Funding J.D.C. was supported in part by the NIH (T32HL087738-12). M.W.S. was supported in part by the NHLBI (K23HL143053). T.W.R. was supported in part by the NIH (U01 HL123033).
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Publication History

Publication Date:
06 May 2019 (online)

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Abstract

One of the defining features of acute respiratory distress syndrome (ARDS) is noncardiogenic pulmonary edema, resulting from increased permeability of the alveolar–capillary barrier and passage of protein-rich fluid into the interstitium and alveolar spaces. The loss of protein from the intravascular space disrupts the normal oncotic pressure differential and causes patients with ARDS to be particularly sensitive to the hydrostatic forces that correlate with intravascular volume. Conservative fluid management, in which diuretics are administered and intravenous fluid administration is minimized, may decrease hydrostatic pressure and increase serum oncotic pressure, potentially limiting the development of pulmonary edema. However, the cause of death in most patients with ARDS is multiorgan system failure, not hypoxemia, and the impact of conservative fluid management on the incidence of extrapulmonary organ failure during ARDS is unclear. These physiologic observations have led to a series of studies examining the impact of fluid management on the development of, resolution of, survival from, and long-term outcomes from ARDS. While questions remain, the current literature makes it clear that fluid management is an integral part of the care of patients with ARDS.

Keywords

acute respiratory distress syndrome - pulmonary edema - hydrostatic pressure - conservative fluid management
 

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