What are the differences in efficacy between fluid-conservative strategies and the fluid-liberal strategies for the treatment of acute respiratory distress syndrome (ARDS)?

Updated: Mar 27, 2020
  • Author: Eloise M Harman, MD; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

An ARDS Clinical Trials Network study of a fluid-conservative strategy versus a fluid-liberal strategy in the management of patients with ARDS or acute lung injury (ALI) found no statistically significant difference in 60-day mortality between the two groups 72 hours after presentation with ARDS. [31] However, patients treated with the fluid-conservative strategy had an improved oxygenation index and lung injury score and an increase in ventilator-free days, without an increase in nonpulmonary organ failures.

It is worth noting that the fluid-conservative group actually had an even rather than a negative fluid balance over the first 7 days, which raises the possibility that the benefit may have been underestimated. Patients whose fluids were managed conservatively did not have an increased need for vasopressors or dialysis. [32]


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