Do hypooncotic fluids for shock increase the risk of late-onset acute respiratory distress syndrome?
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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).
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.
KeywordsARDS Fluid resuscitation Colloids Crystalloids ICU Prognosis
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).
- 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
- 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
- 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.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.MacCabe W, Jackson G (1962) Gram negative bacteremia, etiology and ecology. Arch Intern Med 110:847–855Google Scholar
- 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
- 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
- 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
- 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.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
- 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.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
- 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