What are the disadvantages of a fluid-conservative therapy 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

The use of a conservative fluid management approach has been called into question by the long-term follow-up of a subset of survivors of the Fluid and Catheter Treatment Trial (FACTT). Although mortality in the survivors was similar regardless of fluid management strategy, and the conservative fluid management group required about 18 hours less mechanical ventilatory support, cognitive function was markedly impaired in the conservative fluid group compared with the liberal fluid group, with an adjusted odds ratio of 3.35. [32]

Cognitive impairment was defined as impairment in memory, verbal fluency, or executive function. Although all those were more common in the conservative fluid management group, only the decrement in executive function reached statistical significance (p=0.001). Lower partial pressure of arterial oxygen during the trial was also independently associated with cognitive impairment.


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