The Rationale for Fluid Restriction During Treatment for ARDS

Abstract

Fluid management in adult respiratory distress syndrome (ARDS) has been controversial for some time. Theory, experimental results, and currently available medical data are all consistent with the concept that clinical strategies designed to reduce the accumulation or the resolution of pulmonary edema are associated with improved outcome, especially when implemented during the first few days of ARDS. Clinically, the administration of an intravenous diuretic such as furosemide is the most common method of reducing hydrostatic pressures and extravascular lung water. Experimentally, other maneuvers with similar effects include regional hypoxic ventilation, stellate ganglion ablation, α-adrenergic blockade, and thromboxane inhibition. The current state of knowledge indicates that supportive management strategies that attempt to keep the lowest possible wedge pressure consistent with adequate perfusion are associated with better patient outcome. However, it is important to monitor the patients closely for the potential deleterious effects of excessive intravascular volume reduction. Protocol-guided diuretic management may optimize the chances of success while minimizing the risk of hypovolemia.

Key Words:

pulmonary edema - ARDS - fluid management