Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients — insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis
Abstract Background Increasing evidence indicates the potential benefits of restricted fluid management in critically ill patients. Evidence lacks on the optimal fluid management strategy for invasively ventilated COVID-19 patients. We hypothesized that the cumulative fluid balance would affect the...
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| Format: | Article |
| Language: | English |
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BMC
2022-06-01
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| Series: | Critical Care |
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| Online Access: | https://doi.org/10.1186/s13054-022-04023-y |
| _version_ | 1811241982392008704 |
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| author | Sanchit Ahuja Harm-Jan de Grooth Frederique Paulus Fleur L. van der Ven Ary Serpa Neto Marcus J. Schultz Pieter R. Tuinman PRoVENT-COVID Study Collaborative Group* ‘PRactice of VENTilation in COVID–19’ |
| author_facet | Sanchit Ahuja Harm-Jan de Grooth Frederique Paulus Fleur L. van der Ven Ary Serpa Neto Marcus J. Schultz Pieter R. Tuinman PRoVENT-COVID Study Collaborative Group* ‘PRactice of VENTilation in COVID–19’ |
| author_sort | Sanchit Ahuja |
| collection | DOAJ |
| description | Abstract Background Increasing evidence indicates the potential benefits of restricted fluid management in critically ill patients. Evidence lacks on the optimal fluid management strategy for invasively ventilated COVID-19 patients. We hypothesized that the cumulative fluid balance would affect the successful liberation of invasive ventilation in COVID-19 patients with acute respiratory distress syndrome (ARDS). Methods We analyzed data from the multicenter observational ‘PRactice of VENTilation in COVID-19 patients’ study. Patients with confirmed COVID-19 and ARDS who required invasive ventilation during the first 3 months of the international outbreak (March 1, 2020, to June 2020) across 22 hospitals in the Netherlands were included. The primary outcome was successful liberation of invasive ventilation, modeled as a function of day 3 cumulative fluid balance using Cox proportional hazards models, using the crude and the adjusted association. Sensitivity analyses without missing data and modeling ARDS severity were performed. Results Among 650 patients, three groups were identified. Patients in the higher, intermediate, and lower groups had a median cumulative fluid balance of 1.98 L (1.27–7.72 L), 0.78 L (0.26–1.27 L), and − 0.35 L (− 6.52–0.26 L), respectively. Higher day 3 cumulative fluid balance was significantly associated with a lower probability of successful ventilation liberation (adjusted hazard ratio 0.86, 95% CI 0.77–0.95, P = 0.0047). Sensitivity analyses showed similar results. Conclusions In a cohort of invasively ventilated patients with COVID-19 and ARDS, a higher cumulative fluid balance was associated with a longer ventilation duration, indicating that restricted fluid management in these patients may be beneficial. Trial registration Clinicaltrials.gov ( NCT04346342 ); Date of registration: April 15, 2020. Graphical abstract |
| first_indexed | 2024-04-12T13:44:13Z |
| format | Article |
| id | doaj.art-d60b1e40404e4a7c9db5564bf5873a98 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-12T13:44:13Z |
| publishDate | 2022-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-d60b1e40404e4a7c9db5564bf5873a982022-12-22T03:30:44ZengBMCCritical Care1364-85352022-06-0126111210.1186/s13054-022-04023-yAssociation between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients — insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysisSanchit Ahuja0Harm-Jan de Grooth1Frederique Paulus2Fleur L. van der Ven3Ary Serpa Neto4Marcus J. Schultz5Pieter R. Tuinman6PRoVENT-COVID Study Collaborative Group* ‘PRactice of VENTilation in COVID–19’Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford HospitalDepartment of Intensive Care, Amsterdam UMC, Location VU Medical CenterDepartment of Intensive Care, C3–415, Amsterdam UMC, Location AMCDepartment of Intensive Care, C3–415, Amsterdam UMC, Location AMCDepartment of Critical Care Medicine, Melbourne Medical School, University of Melbourne, Austin HospitalDepartment of Intensive Care, C3–415, Amsterdam UMC, Location AMCDepartment of Intensive Care, Amsterdam UMC, Location VU Medical CenterAbstract Background Increasing evidence indicates the potential benefits of restricted fluid management in critically ill patients. Evidence lacks on the optimal fluid management strategy for invasively ventilated COVID-19 patients. We hypothesized that the cumulative fluid balance would affect the successful liberation of invasive ventilation in COVID-19 patients with acute respiratory distress syndrome (ARDS). Methods We analyzed data from the multicenter observational ‘PRactice of VENTilation in COVID-19 patients’ study. Patients with confirmed COVID-19 and ARDS who required invasive ventilation during the first 3 months of the international outbreak (March 1, 2020, to June 2020) across 22 hospitals in the Netherlands were included. The primary outcome was successful liberation of invasive ventilation, modeled as a function of day 3 cumulative fluid balance using Cox proportional hazards models, using the crude and the adjusted association. Sensitivity analyses without missing data and modeling ARDS severity were performed. Results Among 650 patients, three groups were identified. Patients in the higher, intermediate, and lower groups had a median cumulative fluid balance of 1.98 L (1.27–7.72 L), 0.78 L (0.26–1.27 L), and − 0.35 L (− 6.52–0.26 L), respectively. Higher day 3 cumulative fluid balance was significantly associated with a lower probability of successful ventilation liberation (adjusted hazard ratio 0.86, 95% CI 0.77–0.95, P = 0.0047). Sensitivity analyses showed similar results. Conclusions In a cohort of invasively ventilated patients with COVID-19 and ARDS, a higher cumulative fluid balance was associated with a longer ventilation duration, indicating that restricted fluid management in these patients may be beneficial. Trial registration Clinicaltrials.gov ( NCT04346342 ); Date of registration: April 15, 2020. Graphical abstracthttps://doi.org/10.1186/s13054-022-04023-yCumulative fluid balanceLiberation of ventilationCOVID-19ARDSCritical care |
| spellingShingle | Sanchit Ahuja Harm-Jan de Grooth Frederique Paulus Fleur L. van der Ven Ary Serpa Neto Marcus J. Schultz Pieter R. Tuinman PRoVENT-COVID Study Collaborative Group* ‘PRactice of VENTilation in COVID–19’ Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients — insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis Critical Care Cumulative fluid balance Liberation of ventilation COVID-19 ARDS Critical care |
| title | Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients — insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis |
| title_full | Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients — insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis |
| title_fullStr | Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients — insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis |
| title_full_unstemmed | Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients — insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis |
| title_short | Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients — insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis |
| title_sort | association between early cumulative fluid balance and successful liberation from invasive ventilation in covid 19 ards patients insights from the provent covid study a national multicenter observational cohort analysis |
| topic | Cumulative fluid balance Liberation of ventilation COVID-19 ARDS Critical care |
| url | https://doi.org/10.1186/s13054-022-04023-y |
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