Advertisement

Intensive Care Medicine

, Volume 36, Issue 10, pp 1724–1734 | Cite as

Do hypooncotic fluids for shock increase the risk of late-onset acute respiratory distress syndrome?

  • Frédérique Schortgen
  • Emmanuelle Girou
  • Nicolas Deye
  • Laurent Brochard
  • For the CRYCO Study Group
Original

Abstract

Objective

In patients with shock, late-onset acute respiratory distress syndrome (ARDS) carries poor prognosis. Hypooncotic fluids may improve kidney function preservation, whereas hyperoncotic fluids may in theory decrease the risk of late-onset ARDS. Our objective was to determine whether predominant or exclusive use of crystalloids and/or hypooncotic colloids for shock resuscitation influenced the risk of late-onset ARDS.

Participant and settings

International prospective cohort of consecutive adults who were free of ARDS on admission and who received fluid resuscitation for shock in 115 intensive care units (ICUs) during a 4-week period.

Measurements and results

Severity scores, hemodynamic status, indication for fluids, risk factors for ARDS, plasma expander use, transfusions, and late-onset ARDS were recorded prospectively. Logistic regression models were tested to determine whether predominant or exclusive use of hypooncotic fluids was associated with higher incidence of late-onset ARDS. Of 905 patients, 81 [8.9%; 95% confidence interval (CI) 7.2–11.0] developed ARDS, with no difference between patients given only hypooncotic fluids (10.4%; 95% CI 7.6–13.7) and the other patients (7.7%; 95% CI 5.5–10.5; p = 0.16). Late-onset ARDS was significantly associated with sepsis [odds ratio (OR) 1.90; 95% CI 1.06–3.40], worse chest X-ray score at fluid initiation (1.55; 95% CI 1.27–1.91), positive fluid balance (1.06 per l; 95% CI 1.02–1.09), and greater transfusion volume (1.14 per l; 95% CI 1.01–1.29). The proportion of hypooncotic fluids in the plasma expander regimen was not associated with late-onset ARDS (1.01 per %; 95% CI 0.99–1.01).

Conclusions

Based on this observational study, there is no evidence that in patients with shock the use of hypooncotic fluids increases the risk of late-onset ARDS. This finding needs to be confirmed.

Keywords

ARDS Fluid resuscitation Colloids Crystalloids ICU Prognosis 

Notes

Acknowledgments

This study was supported by grant Projet Hospitalier de Recherche Clinique AOM00120 from the Assistance Publique-Hôpitaux de Paris (Paris Teaching Hospital Network, a nonprofit, publicly funded organization).

Supplementary material

134_2010_1905_MOESM1_ESM.doc (124 kb)
Supplementary material 1 (DOC 124 kb)

References

  1. 1.
    Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguia C, Nightingale P, Arroliga AC, Tobin MJ (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287:345–355CrossRefPubMedGoogle Scholar
  2. 2.
    Gajic O, Frutos-Vivar F, Esteban A, Hubmayr RD, Anzueto A (2005) Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients. Intensive Care Med 31:922–926CrossRefPubMedGoogle Scholar
  3. 3.
    Humphrey H, Hall J, Sznajder I, Silverstein M, Wood L (1990) Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure. Chest 97:1176–1180CrossRefPubMedGoogle Scholar
  4. 4.
    Schuller D, Mitchell JP, Calandrino FS, Schuster DP (1991) Fluid balance during pulmonary edema. Is fluid gain a marker or a cause of poor outcome? Chest 100:1068–1075CrossRefPubMedGoogle Scholar
  5. 5.
    Simmons RS, Berdine GG, Seidenfeld JJ, Prihoda TJ, Harris GD, Smith JD, Gilbert TJ, Mota E, Johanson WG Jr (1987) Fluid balance and the adult respiratory distress syndrome. Am Rev Respir Dis 135:924–929PubMedGoogle Scholar
  6. 6.
    Sakr Y, Vincent JL, Reinhart K, Groeneveld J, Michalopoulos A, Sprung CL, Artigas A, Ranieri VM (2005) High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury. Chest 128:3098–3108CrossRefPubMedGoogle Scholar
  7. 7.
    Mitchell JP, Schuller D, Calandrino FS, Schuster DP (1992) Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization. Am Rev Respir Dis 145:990–998PubMedGoogle Scholar
  8. 8.
    Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL (2006) Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 354:2564–2575CrossRefPubMedGoogle Scholar
  9. 9.
    (2004) Evidence-based colloid use in the critically ill: American Thoracic Society Consensus Statement. Am J Respir Crit Care Med 170:1247–1259Google Scholar
  10. 10.
    Brigham K, Woolverton X, Blake L, Staub N (1974) Increased sheep lung vascular permeability caused by pseudomonas bacteremia. J Clin Invest 54:792CrossRefPubMedGoogle Scholar
  11. 11.
    Powers KA, Kapus A, Khadaroo RG, He R, Marshall JC, Lindsay TF, Rotstein OD (2003) Twenty-five percent albumin prevents lung injury following shock/resuscitation. Crit Care Med 31:2355–2363CrossRefPubMedGoogle Scholar
  12. 12.
    Quinlan GJ, Mumby S, Martin GS, Bernard GR, Gutteridge JM, Evans TW (2004) Albumin influences total plasma antioxidant capacity favorably in patients with acute lung injury. Crit Care Med 32:755–759CrossRefPubMedGoogle Scholar
  13. 13.
    Rittoo D, Gosling P, Burnley S, Bonnici C, Millns P, Simms MH, Smith SR, Vohra RK (2004) Randomized study comparing the effects of hydroxyethyl starch solution with Gelofusine on pulmonary function in patients undergoing abdominal aortic aneurysm surgery. Br J Anaesth 92:61–66CrossRefPubMedGoogle Scholar
  14. 14.
    Staub NC (1978) Pulmonary edema: physiologic approaches to management. Chest 74:559–564CrossRefPubMedGoogle Scholar
  15. 15.
    Ashbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratory distress in adults. Lancet 2:319–323CrossRefPubMedGoogle Scholar
  16. 16.
    Schortgen F, Deye N, Brochard L (2004) Preferred plasma volume expanders for critically ill patients: results of an international survey. Intensive Care Med 30:2222–2229CrossRefPubMedGoogle Scholar
  17. 17.
    Choi PT, Yip G, Quinonez LG, Cook DJ (1999) Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med 27:200–210CrossRefPubMedGoogle Scholar
  18. 18.
    The SAFE Study Investigators (2004) A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 350:2247–2256CrossRefGoogle Scholar
  19. 19.
    Schortgen F, Girou E, Deye N, Brochard L (2008) The risk associated with hyperoncotic colloids in patients with shock. Intensive Care Med 34:2157–2168CrossRefPubMedGoogle Scholar
  20. 20.
    (1992) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874Google Scholar
  21. 21.
    Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, LeGall JR, Morris A, Spragg R (1994) Report of the American–European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. The Consensus Committee. Intensive Care Med 20:225–232CrossRefPubMedGoogle Scholar
  22. 22.
    MacCabe W, Jackson G (1962) Gram negative bacteremia, etiology and ecology. Arch Intern Med 110:847–855Google Scholar
  23. 23.
    Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963CrossRefPubMedGoogle Scholar
  24. 24.
    Le Gall JR, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A, Teres D (1996) The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA 276:802–810CrossRefPubMedGoogle Scholar
  25. 25.
    Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710CrossRefPubMedGoogle Scholar
  26. 26.
    Murray JF, Matthay MA, Luce JM, Flick MR (1988) An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 138:720–723PubMedGoogle Scholar
  27. 27.
    Croce MA, Fabian TC, Davis KA, Gavin TJ (1999) Early and late acute respiratory distress syndrome: two distinct clinical entities. J Trauma 46: 361–366 (discussion 366–368)Google Scholar
  28. 28.
    Vassar MJ, Moore J, Perry CA, Spisso J, Holcroft JW (1988) Early fluid requirements in trauma patients. A predictor of pulmonary failure and mortality. Arch Surg 123:1149–1157PubMedGoogle Scholar
  29. 29.
    Gajic O, Dara SI, Mendez JL, Adesanya AO, Festic E, Caples SM, Rana R, St Sauver JL, Lymp JF, Afessa B, Hubmayr RD (2004) Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med 32:1817–1824CrossRefPubMedGoogle Scholar
  30. 30.
    Jia X, Malhotra A, Saeed M, Mark RG, Talmor D (2008) Risk factors for ARDS in patients receiving mechanical ventilation for >48 h. Chest 133:853–861CrossRefPubMedGoogle Scholar
  31. 31.
    Moore FA, McKinley BA, Moore EE (2004) The next generation in shock resuscitation. Lancet 363:1988–1996CrossRefPubMedGoogle Scholar
  32. 32.
    Virgilio RW, Rice CL, Smith DE, James DR, Zarins CK, Hobelmann CF, Peters RM (1979) Crystalloid vs. colloid resuscitation: is one better? A randomized clinical study. Surgery 85:129–139PubMedGoogle Scholar
  33. 33.
    Martin GS, Moss M, Wheeler AP, Mealer M, Morris JA, Bernard GR (2005) A randomized, controlled trial of furosemide with or without albumin in hypoproteinemic patients with acute lung injury. Crit Care Med 33:1681–1687CrossRefPubMedGoogle Scholar
  34. 34.
    Sibbald WJ, Driedger AA, Wells GA, Myers ML, Lefcoe M (1983) The short-term effects of increasing plasma colloid osmotic pressure in patients with noncardiac pulmonary edema. Surgery 93:620–633PubMedGoogle Scholar
  35. 35.
    Schortgen F, Brochard L (2009) Reply to wiedermann. Intensive Care Med 35:382–383CrossRefGoogle Scholar
  36. 36.
    Matthay MA, Berthiaume Y, Staub NC (1985) Long-term clearance of liquid and protein from the lungs of unanesthetized sheep. J Appl Physiol 59:928–934PubMedGoogle Scholar
  37. 37.
    Rackow EC, Falk JL, Fein IA, Siegel JS, Packman MI, Haupt MT, Kaufman BS, Putnam D (1983) Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock. Crit Care Med 11:839–850CrossRefPubMedGoogle Scholar
  38. 38.
    Skillman JJ, Restall DS, Salzman EW (1975) Randomized trial of albumin vs. early fluid requirements in trauma patients. Surgery 78:291–303PubMedGoogle Scholar
  39. 39.
    van der Heijden M, Verheij J, van Nieuw Amerongen GP, Groeneveld AB (2009) Crystalloid or colloid fluid loading and pulmonary permeability, edema, and injury in septic and nonseptic critically ill patients with hypovolemia. Crit Care Med 24:24Google Scholar
  40. 40.
    Verheij J, van Lingen A, Raijmakers PGHM, Rijnsburger ER, Veerman DP, Wisselink W, Girbes ARJ, Groeneveld ABJ (2006) Effect of fluid loading with saline or colloids on pulmonary permeability, oedema and lung injury score after cardiac and major vascular surgery. Br J Anaesth 96:21–30CrossRefPubMedGoogle Scholar
  41. 41.
    Molnar Z, Mikor A, Leiner T, Szakmany T (2004) Fluid resuscitation with colloids of different molecular weight in septic shock. Intensive Care Med 30:1356–1360CrossRefPubMedGoogle Scholar
  42. 42.
    Finfer S, Bellomo R, McEvoy S, Lo SK, Myburgh J, Neal B, Norton R (2006) Effect of baseline serum albumin concentration on outcome of resuscitation with albumin or saline in patients in intensive care units: analysis of data from the saline versus albumin fluid evaluation (SAFE) study. BMJ 333:1044–1046CrossRefPubMedGoogle Scholar
  43. 43.
    Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Hartog C, Natanson C, Loeffler M, Reinhart K, the German Competence Network S (2008) Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 358:125–139CrossRefPubMedGoogle Scholar
  44. 44.
    Schortgen F, Lacherade JC, Bruneel F, Cattaneo I, Hemery F, Lemaire F, Brochard L (2001) Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study. Lancet 357:911–916CrossRefPubMedGoogle Scholar
  45. 45.
    Hudson LD, Milberg JA, Anardi D, Maunder RJ (1995) Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care Med 151:293–301PubMedGoogle Scholar
  46. 46.
    Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E, The Transfusion Requirements in Critical Care Investigators for the Canadian Critical Care Trials Group (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 340:409–417CrossRefPubMedGoogle Scholar
  47. 47.
    Gong MN, Thompson BT, Williams P, Pothier L, Boyce PD, Christiani DC (2005) Clinical predictors of and mortality in acute respiratory distress syndrome: potential role of red cell transfusion. Crit Care Med 33:1191–1198CrossRefPubMedGoogle Scholar
  48. 48.
    Gajic O, Rana R, Mendez JL, Rickman OB, Lymp JF, Hubmayr RD, Moore SB (2004) Acute lung injury after blood transfusion in mechanically ventilated patients. Transfusion 44:1468–1474CrossRefPubMedGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Frédérique Schortgen
    • 1
    • 2
  • Emmanuelle Girou
    • 3
    • 4
  • Nicolas Deye
    • 5
  • Laurent Brochard
    • 1
    • 2
    • 4
  • For the CRYCO Study Group
  1. 1.Service de réanimation médicaleAP-HP, Groupe Hospitalier Albert Chenevier–Henri MondorCréteilFrance
  2. 2.Faculté de MédecineINSERM, U955CréteilFrance
  3. 3.Unité de Contrôle, Epidémiologie et Prévention de l’InfectionAP-HP, Groupe Hospitalier Albert Chenevier–Henri MondorCréteilFrance
  4. 4.Faculté de MédecineUniversité Paris 12CréteilFrance
  5. 5.Réanimation Médicale et ToxicologiqueAPHP, Hôpital Lariboisière-Fernand WidalParisFrance

Personalised recommendations