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. Graphical abstract: [Figure not available: see fulltext.]
Original language | English |
---|---|
Article number | 157 |
Number of pages | 12 |
Journal | Critical Care |
Volume | 26 |
Issue number | 1 |
DOIs | |
Publication status | Published - Dec 2022 |
Keywords
- ARDS
- COVID-19
- Critical care
- Cumulative fluid balance
- Liberation of ventilation
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In: Critical Care, Vol. 26, No. 1, 157, 12.2022.
Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients — insights from the PRoVENT-COVID study
T2 - a national, multicenter, observational cohort analysis
AU - Ahuja, Sanchit
AU - de Grooth, Harm Jan
AU - Paulus, Frederique
AU - van der Ven, Fleur L.
AU - Serpa Neto, Ary
AU - Schultz, M. J.
AU - Tuinman, Pieter R.
AU - van Akkeren, J. P.
AU - Algera, A. G.
AU - Algoe, C. K.
AU - van Amstel, R. B.
AU - Artigas, A.
AU - Baur, O. L.
AU - van de Berg, P.
AU - van den Berg, A. E.
AU - Bergmans, D. C.J.J.
AU - van den Bersselaar, D. I.
AU - Bertens, F. A.
AU - Bindels, A. J.G.H.
AU - de Boer, M. M.
AU - den Boer, S.
AU - Boers, L. S.
AU - Bogerd, M.
AU - Bos, L. D.J.
AU - Botta, M.
AU - Breel, J. S.
AU - de Bruin, H.
AU - de Bruin, S.
AU - Bruna, C. L.
AU - Buiteman-Kruizinga, L. A.
AU - Cremer, O. L.
AU - Determann, R. M.
AU - Dieperink, W.
AU - Dongelmans, D. A.
AU - Franke, H. S.
AU - Galek-Aldridge, M. S.
AU - de Graaff, M. J.
AU - Hagens, L. A.
AU - Haringman, J. J.
AU - van der Heide, S. T.
AU - van der Heiden, P. L.J.
AU - Heijnen, N. F.L.
AU - Hiel, S. J.P.
AU - Hoeijmakers, L. L.
AU - Hol, L.
AU - Hollmann, M. W.
AU - Hoogendoorn, M. E.
AU - Horn, J.
AU - van der Horst, R.
AU - Ie, E. L.K.
AU - Ivanov, D.
AU - Juffermans, N. P.
AU - Kho, E.
AU - de Klerk, E. S.
AU - Koopman-van Gemert, A. W.M.M.
AU - Koopmans, M.
AU - Kucukcelebi, S.
AU - Kuiper, M. A.
AU - de Lange, D. W.
AU - van Mourik, N.
AU - Nijbroek, S. G.
AU - Onrust, M.
AU - Oostdijk, E. A.N.
AU - Pennartz, C. J.
AU - Pillay, J.
AU - Pisani, L.
AU - Purmer, I. M.
AU - Rettig, T. C.D.
AU - Roozeman, J. P.
AU - Schuijt, M. T.U.
AU - Sleeswijk, M. E.
AU - Smit, M. R.
AU - Spronk, P. E.
AU - Stilma, W.
AU - Strang, A. C.
AU - Tsonas, A. M.
AU - Tuinman, P. R.
AU - Valk, C. M.A.
AU - Veen-Schra, F. L.
AU - Veldhuis, L. I.
AU - van Velzen, P.
AU - van der Ven, W. H.
AU - Vlaar, A. P.J.
AU - van Vliet, P.
AU - van der Voort, P. H.J.
AU - van Welie, L.
AU - Wesselink, H. J.F.T.
AU - van der Wier-Lubbers, H. H.
AU - van Wijk, B.
AU - Winters, T.
AU - Wong, W. Y.
AU - van Zanten, A. R.H.
AU - PRoVENT-COVID Study Collaborative Group ‘PRactice of VENTilation in COVID–19’
N1 - Funding Information: *PRoVENT-COVID Collaborative Group. Investigators: (in alphabetic order): S. Ahuja1; J.P. van Akkeren2; A.G. Algera3; C.K. Algoe3; R.B. van Amstel3; A. Artigas4; O.L. Baur3; P. van de Berg5; A.E. van den Berg6; D.C.J.J. Bergmans7; D.I. van den Bersselaar3; F.A. Bertens3; A.J.G.H. Bindels5; M.M. de Boer3; S. den Boer8; L.S. Boers3; M. Bogerd3; L.D.J. Bos3; M. Botta3; J.S. Breel9; H. de Bruin3; S. de Bruin3; C.L. Bruna3; L.A. Buiteman–Kruizinga10; O. L. Cremer11; R.M. Determann12; W. Dieperink13; D.A. Dongelmans3; H.S. Franke13; M.S. Galek-Aldridge3; M.J. de Graaff14; L.A. Hagens3; J.J. Haringman16; S.T. van der Heide3; P.L.J. van der Heiden10; N.F.L. Heijnen15; S.J.P. Hiel2; L.L. Hoeijmakers3; L. Hol3,9; M.W. Hollmann9; M.E. Hoogendoorn16; J. Horn3; R. van der Horst17; E.L.K. Ie3; D. Ivanov3; N.P. Juffermans12; E. Kho3; E.S. de Klerk9; A.W.M.M. Koopman-van Gemert18; M. Koopmans12; S. Kucukcelebi3; M.A. Kuiper19; D.W. de Lange11; N. van Mourik3; S.G. Nijbroek3,9; M. Onrust13; E.A.N. Oostdijk20; F. Paulus3,21; C.J. Pennartz3; J. Pillay3,13; L. Pisani3; I.M. Purmer6; T.C.D. Rettig22; J.P. Roozeman3; M.T.U. Schuijt3; M.J. Schultz3,23,24; A. Serpa Neto25; M.E. Sleeswijk26; M.R. Smit3; P.E. Spronk27; W. Stilma3; A.C. Strang28; A.M. Tsonas3; P.R. Tuinman29; C.M.A. Valk3; F.L. Veen-Schra16; L.I. Veldhuis3; P. van Velzen30; W.H. van der Ven9; A.P.J. Vlaar3; P. van Vliet31; P.H.J. van der Voort13; L. van Welie32; H.J.F.T. Wesselink16; H.H. van der Wier-Lubbers16; B. van Wijk3; T. Winters3; W.Y. Wong3; A.R.H. van Zanten32. Institutional and Departmental Affiliations:1Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health, Detroit, Michigan, United States;2Department of Intensive Care, Maxima Medical Center, Eindhoven, The Netherlands;3Department of Intensive Care, Amsterdam University Medical Centers, location ‘Academic Medical Center,’ Amsterdam, The Netherlands;4Critical Care Center, Sabadell Hospital, Sabadell, Spain;5Department of Intensive Care, Catharina Hospital, Eindhoven, The Netherlands;6Department of Intensive Care, Haga Hospital, the Hague, The Netherlands;7Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands;8Department of Intensive Care, Spaarne Hospital, Haarlem, The Netherlands;9Department of Anaesthesiology, Amsterdam University Medical Centers, location ‘Academic Medical Center,’ Amsterdam, The Netherlands;10Department of Intensive Care, Reinier de Graaf Hospital, Delft, The Netherlands;11Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands;12Department of Intensive Care, OLVG Hospital, location East, Amsterdam, The Netherlands;13Department of Intensive Care, University Medical Center Groningen, Groningen, The Netherlands;14Department of Intensive Care, Sint Antonius Hospital, Nieuwegein, The Netherlands;15Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands;16Department of Intensive Care, Isala Hospital, Zwolle, The Netherlands;17Department of Intensive Care; Zuyderland Hospital, Heerlen and Sittard, The Netherlands;18Department of Intensive Care ZGT Hospital, Almelo, The Netherlands;19Department of Intensive Care Medical Center Leeuwarden, Leeuwarden, The Netherlands;20Department of Intensive Care; Maasstad Hospital, Rotterdam, The Netherlands;21ACHIEVE, Center of Applied Research Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, The Netherlands;22Department of Intensive Care Amphia Hospital, Breda, The Netherlands;23Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand;24Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom;25Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Center (ANZIC-RC), Monash University, Melbourne, Australia;26Department of Intensive Care, FlevoHospital, Almere, The Netherlands;27Department of Intensive Care, Gelre Hospital, Apeldoorn and Zutphen, The Netherlands:;28Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands;29Department of Intensive Care, Amsterdam University Medical Centers, location ‘VU Medical Center,’ Amsterdam, The Netherlands;30Department of Intensive Care, Dijklander Hospital, location Hoorn, Hoorn, The Netherlands;31Department of Intensive Care Haaglanden Medical Center, location Westeinde, the Hague, The Netherlands;32Department of Intensive Care Gelderse Vallei Hospital, Ede, The Netherlands. Publisher Copyright: © 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - 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. Graphical abstract: [Figure not available: see fulltext.]
AB - 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. Graphical abstract: [Figure not available: see fulltext.]
KW - ARDS
KW - COVID-19
KW - Critical care
KW - Cumulative fluid balance
KW - Liberation of ventilation
UR - http://www.scopus.com/inward/record.url?scp=85131270278&partnerID=8YFLogxK
U2 - 10.1186/s13054-022-04023-y
DO - 10.1186/s13054-022-04023-y
M3 - Article
C2 - 35650616
AN - SCOPUS:85131270278
SN - 1364-8535
VL - 26
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 157
ER -