Observational Study

. 2022 Jun 1;26(1):157.

doi: 10.1186/s13054-022-04023-y.

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

Collaborators, Affiliations

Collaborators

PRoVENT-COVID Study Collaborative Group* ‘PRactice of VENTilation in COVID–19’:
S Ahuja, J P van Akkeren, A G Algera, C K Algoe, R B van Amstel, A Artigas, O L Baur, P van de Berg, A E van den Berg, D C J J Bergmans, D I van den Bersselaar, F A Bertens, A J G H Bindels, M M de Boer, S den Boer, L S Boers, M Bogerd, L D J Bos, M Botta, J S Breel, H de Bruin, S de Bruin, C L Bruna, L A Buiteman-Kruizinga, O L Cremer, R M Determann, W Dieperink, D A Dongelmans, H S Franke, M S Galek-Aldridge, M J de Graaff, L A Hagens, J J Haringman, S T van der Heide, P L J van der Heiden, N F L Heijnen, S J P Hiel, L L Hoeijmakers, L Hol, M W Hollmann, M E Hoogendoorn, J Horn, R van der Horst, E L K Ie, D Ivanov, N P Juffermans, E Kho, E S de Klerk, A W M M Koopman-van Gemert, M Koopmans, S Kucukcelebi, M A Kuiper, D W de Lange, N van Mourik, S G Nijbroek, M Onrust, E A N Oostdijk, F Paulus, C J Pennartz, J Pillay, L Pisani, I M Purmer, T C D Rettig, J P Roozeman, M T U Schuijt, M J Schultz, A Serpa Neto, M E Sleeswijk, M R Smit, P E Spronk, W Stilma, A C Strang, A M Tsonas, P R Tuinman, C M A Valk, F L Veen-Schra, L I Veldhuis, P van Velzen, W H van der Ven, A P J Vlaar, P van Vliet, P H J van der Voort, L van Welie, H J F T Wesselink, H H van der Wier-Lubbers, B van Wijk, T Winters, W Y Wong, A R H van Zanten

Affiliations

¹ Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, Detroit, MI, USA.
² Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA.
³ Department of Intensive Care, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands.
⁴ Department of Intensive Care, C3-415, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
⁵ ACHIEVE, Faculty of Health, Centre of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
⁶ Department of Critical Care Medicine, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia.
⁷ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
⁸ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁹ Department of Intensive Care, C3-415, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. m.j.schultz@amsterdamumc.nl.
¹⁰ Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand. m.j.schultz@amsterdamumc.nl.
¹¹ Nuffield Department of Medicine, University of Oxford, Oxford, UK. m.j.schultz@amsterdamumc.nl.

PMID: 35650616
PMCID: PMC9157033
DOI: 10.1186/s13054-022-04023-y

Observational Study

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 et al. Crit Care. 2022.

. 2022 Jun 1;26(1):157.

doi: 10.1186/s13054-022-04023-y.

Collaborators

PRoVENT-COVID Study Collaborative Group* ‘PRactice of VENTilation in COVID–19’:
S Ahuja, J P van Akkeren, A G Algera, C K Algoe, R B van Amstel, A Artigas, O L Baur, P van de Berg, A E van den Berg, D C J J Bergmans, D I van den Bersselaar, F A Bertens, A J G H Bindels, M M de Boer, S den Boer, L S Boers, M Bogerd, L D J Bos, M Botta, J S Breel, H de Bruin, S de Bruin, C L Bruna, L A Buiteman-Kruizinga, O L Cremer, R M Determann, W Dieperink, D A Dongelmans, H S Franke, M S Galek-Aldridge, M J de Graaff, L A Hagens, J J Haringman, S T van der Heide, P L J van der Heiden, N F L Heijnen, S J P Hiel, L L Hoeijmakers, L Hol, M W Hollmann, M E Hoogendoorn, J Horn, R van der Horst, E L K Ie, D Ivanov, N P Juffermans, E Kho, E S de Klerk, A W M M Koopman-van Gemert, M Koopmans, S Kucukcelebi, M A Kuiper, D W de Lange, N van Mourik, S G Nijbroek, M Onrust, E A N Oostdijk, F Paulus, C J Pennartz, J Pillay, L Pisani, I M Purmer, T C D Rettig, J P Roozeman, M T U Schuijt, M J Schultz, A Serpa Neto, M E Sleeswijk, M R Smit, P E Spronk, W Stilma, A C Strang, A M Tsonas, P R Tuinman, C M A Valk, F L Veen-Schra, L I Veldhuis, P van Velzen, W H van der Ven, A P J Vlaar, P van Vliet, P H J van der Voort, L van Welie, H J F T Wesselink, H H van der Wier-Lubbers, B van Wijk, T Winters, W Y Wong, A R H van Zanten

Affiliations

¹ Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, Detroit, MI, USA.
² Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA.
³ Department of Intensive Care, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands.
⁴ Department of Intensive Care, C3-415, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
⁵ ACHIEVE, Faculty of Health, Centre of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
⁶ Department of Critical Care Medicine, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, Australia.
⁷ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
⁸ Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
⁹ Department of Intensive Care, C3-415, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. m.j.schultz@amsterdamumc.nl.
¹⁰ Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand. m.j.schultz@amsterdamumc.nl.
¹¹ Nuffield Department of Medicine, University of Oxford, Oxford, UK. m.j.schultz@amsterdamumc.nl.

PMID: 35650616
PMCID: PMC9157033
DOI: 10.1186/s13054-022-04023-y

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.

Keywords: ARDS; COVID-19; Critical care; Cumulative fluid balance; Liberation of ventilation.

PubMed Disclaimer

Conflict of interest statement

All authors declare no competing interests related to the submitted work.

Figures

**Fig. 2**
Survival and marginal effect plots. a Survival plots (unadjusted and adjusted) showing predicted probability of successful liberation of invasive ventilation as a function of day 3 fluid balance—separated in tertiles. b Marginal effect (unadjusted and adjusted) of day 3 cumulative fluid balance on the hazard of successful liberation from invasive ventilation after adjustment for predefined confounding variables. A higher day 3 cumulative fluid balance was associated with a lower hazard (i.e., a lower probability over time) of successful liberation

**Fig. 3**
Sensitivity analysis showing the consistency of main effect over ARDS severity. *ARDS* acute respiratory distress syndrome

See this image and copyright information in PMC

Comment in

Fluid intake, fluid output or fluid balance, which one matters in ARDS.
Shen Y, Cai G, Yan J. Shen Y, et al. Crit Care. 2022 Nov 14;26(1):352. doi: 10.1186/s13054-022-04188-6. Crit Care. 2022. PMID: 36376940 Free PMC article. No abstract available.

References

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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

Collaborators

Affiliations

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

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

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Medical

Miscellaneous