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Fluid and Nutritional Management of ARDS: What Is the Ideal Fluid and Nutritional Management for an ARDS Patient?

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Acute Respiratory Distress Syndrome

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Abstract

Acute respiratory distress syndrome (ARDS) is a life-threatening condition with complicated pathogenesis. Adequate fluid and nutritional managements would have potentials to improve outcome of ARDS. Conservative fluid management would be preferable compared with liberal fluid management in terms of preventing severe pulmonary edema and improving a resultant poor prognosis. However, potential risk of cognitive impairment should be noted in conservative fluid management. Central venous pressure and pulmonary artery occlusion pressure can be useful surrogates for achieving adequate fluid management. Combined use of diuretics and albumin would be an alternative option to improve fluid balance, oxygenation, and hemodynamic stability. Regarding nutritional management, if oral intake is not possible, early enteral nutrition initiated within 48 h is recommended rather than delaying enteral nutrition or any parenteral nutrition. Target energy can be calculated by using indirect calorimetry or eight-based equations (i.e., 20–25 kcal/kg/day). Gradual increase in providing feeding would be preferable for avoiding refeeding syndrome. Insulin can be used for achieving the target concentration of blood glucose level of 6–8 mmol/L (108–144 mg/dL). Omega-3 fatty acid is likely to be beneficial for treating ARDS, although the results of randomized controlled trials remain controversial. Further studies are necessary to confirm the beneficial effects of adequate fluid and nutritional managements on ARDS.

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Abbreviations

ARDS:

Acute respiratory distress syndrome

BALF:

Bronchoalveolar lavage fluid

CI:

Confidence interval

CNS:

Central nervous system

COVID-19:

Coronavirus disease 2019

CVP:

Central venous pressure

DHA:

Docosahexaenoic acid

EN:

Enteral nutrition

EPA:

Eicosapentaenoic acid

ESPEN:

European Society for Clinical Nutrition and Metabolism

EVLW:

Extravascular lung water

FIO2:

Fraction of inspiratory oxygen

GLA:

Gamma-linolenic acid

HR:

Hazard ratio

ICU:

Intensive care unit

IL:

Interleukin

OR:

Odds ratio

PaO2:

Partial pressure of arterial oxygen

PAOP:

Pulmonary artery occlusion pressure

PEEP:

Positive end-expiratory pressure

PN:

Parenteral nutrition

RCT:

Randomized, control trial

REE:

Resting energy expenditure

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus 2

SMD:

Standardized mean difference

SOFA:

Sequential organ failure assessment

VCO2:

Carbon dioxide production

VO2:

Oxygen consumption

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Authors and Affiliations

  1. Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Shinichiro Ohshimo

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  1. Shinichiro Ohshimo
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Correspondence to Shinichiro Ohshimo .

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  1. Department of Respiratory Medicine, Hirosaki University, Graduate School of Medicine, Hirosaki, Japan

    Sadatomo Tasaka

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Ohshimo, S. (2022). Fluid and Nutritional Management of ARDS: What Is the Ideal Fluid and Nutritional Management for an ARDS Patient?. In: Tasaka, S. (eds) Acute Respiratory Distress Syndrome. Respiratory Disease Series: Diagnostic Tools and Disease Managements. Springer, Singapore. https://doi.org/10.1007/978-981-16-8371-8_8

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  • DOI: https://doi.org/10.1007/978-981-16-8371-8_8

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  • Publisher Name: Springer, Singapore

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  • Online ISBN: 978-981-16-8371-8

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