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World Journal of Emergency Medicine ›› 2020, Vol. 11 ›› Issue (4): 216-222.doi: 10.5847/wjem.j.1920-8642.2020.04.003

Special Issue: Sepsis

• Original Article • Previous Articles     Next Articles

Effects of fluid balance on prognosis of acute respiratory distress syndrome patients secondary to sepsis

Yu-ming Wang1, Yan-jun Zheng1, Ying Chen1, Yun-chuan Huang1, Wei-wei Chen1, Ran Ji1, Li-li Xu1, Zhi-tao Yang1, Hui-qiu Sheng1, Hong-ping Qu2, En-qiang Mao1(), Er-zhen Chen1()   

  1. 1 Department of Emergency, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai,China
    2 Department of Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • Received:2019-11-01 Accepted:2020-05-20 Online:2020-10-01 Published:2020-10-01
  • Contact: En-qiang Mao,Er-zhen Chen E-mail:maoeq@yeah.net;chenerzhen@hotmail.com

Abstract:

BACKGROUND: Fluid management is crucial to acute respiratory distress syndrome (ARDS) secondary to sepsis. However, choices of fluid resuscitation strategies and fluid input volumes remain a thorny problem. Our study aimed to elucidate the relationship between fluid balance and prognosis of ARDS patients secondary to sepsis.

METHODS: Our study included 322 sepsis patients from Ruijin Hospital between 2014 and 2018, and 84 patients were diagnosed as ARDS within 72 hours after onset of sepsis according to Berlin ARDS Definition.

RESULTS: Among the 322 sepsis patients, 84 (26.1%) were complicated with ARDS within 72 hours. ARDS patients had a lower oxygenation index (PaO2/FiO2 166.4±71.0 vs. 255.0±91.2, P<0.05), longer duration of mechanical ventilation (11 [6-24] days vs. 0 [0-0] days, P<0.05) than those without ARDS. Sepsis patients with ARDS showed daily positive net fluid balance during seven days compared with those without ARDS who showed daily negative net fluid balance since the second day with significant statistical differences. Among the 84 sepsis patients with ARDS, 58 (69.0%) died. Mean daily fluid input volumes were much lower in survivors than in non-survivors (43.2±16.7 mL/kg vs. 51.0±25.2 mL/kg, P<0.05) while output volumes were much higher in survivors (45.2±19.8 mL/kg vs. 40.2±22.7 mL/kg, P<0.05). Using binary logistic regression analysis, we found that the mean daily fluid balance was independently associated with mortality of sepsis patients complicating with ARDS (P<0.05).

CONCLUSIONS: Early negative fluid balance is independently associated with a better prognosis of sepsis patients complicated with ARDS.

Key words: Sepsis, Acute respiratory distress syndrome, Fluid balance, Prognosis