Comparison of Two Fluid-Management Strategies in Acute Lung Injury

The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network

doi:10.1056/nejmoa062200

Cited by 3,538Respiratory Support and MechanismsHemodynamic Monitoring and TherapySepsis Diagnosis and Treatment

Comparison of Two Fluid-Management Strategies in Acute Lung Injury

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The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network·2006·New England Journal of Medicine

DOI 10.1056/nejmoa062200

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Abstract

BACKGROUND: Optimal fluid management in patients with acute lung injury is unknown. Diuresis or fluid restriction may improve lung function but could jeopardize extrapulmonary-organ perfusion. METHODS: In a randomized study, we compared a conservative and a liberal strategy of fluid management using explicit protocols applied for seven days in 1000 patients with acute lung injury. The primary end point was death at 60 days. Secondary end points included the number of ventilator-free days and organ-failure-free days and measures of lung physiology. RESULTS: The rate of death at 60 days was 25.5 percent in the conservative-strategy group and 28.4 percent in the liberal-strategy group (P=0.30; 95 percent confidence interval for the difference, -2.6 to 8.4 percent). The mean (+/-SE) cumulative fluid balance during the first seven days was -136+/-491 ml in the conservative-strategy group and 6992+/-502 ml in the liberal-strategy group (P<0.001). As compared with the liberal strategy, the conservative strategy improved the oxygenation index ([mean airway pressure x the ratio of the fraction of inspired oxygen to the partial pressure of arterial oxygen]x100) and the lung injury score and increased the number of ventilator-free days (14.6+/-0.5 vs. 12.1+/-0.5, P<0.001) and days not spent in the intensive care unit (13.4+/-0.4 vs. 11.2+/-0.4, P<0.001) during the first 28 days but did not increase the incidence or prevalence of shock during the study or the use of dialysis during the first 60 days (10 percent vs. 14 percent, P=0.06). CONCLUSIONS: Although there was no significant difference in the primary outcome of 60-day mortality, the conservative strategy of fluid management improved lung function and shortened the duration of mechanical ventilation and intensive care without increasing nonpulmonary-organ failures. These results support the use of a conservative strategy of fluid management in patients with acute lung injury. (ClinicalTrials.gov number, NCT00281268 [ClinicalTrials.gov].).

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Two trials investigating intravenous fluid restriction in patients with acute lung injury or septic shock produced conflicting results.
“However, two trials investigating intravenous fluid restriction in patients with acute lung injury or septic shock produced conflicting results.29,30”
From Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3). (2023) · cites this paper as [30]

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Authors: The National Heart, L.
Corresponding author: The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 2006-06-15
Volume: 354
Issue: 24
Pages: 2564-2575
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejmoa062200
OpenAlex: W2314787815
Cited by: 3,538
References: 1
Citations by year: 2026: 103 · 2025: 103 · 2024: 127 · 2023: 160 · 2022: 208 · 2021: 204 · 2020: 232 · 2019: 190 · 2018: 174 · 2017: 181 · 2016: 227 · 2015: 180 · 2014: 215 · 2013: 216 · 2012: 207
FWCI: 125.93
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (n01hr016146-000)
National Heart, Lung, and Blood Institute (N01-HR46046-64, N01-HR-16146-54)
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Keywords: acute lung injury, fluid management, liberal fluid strategy, diuresis, fluid restriction, 60-day mortality, ventilator-free days, organ failure, oxygenation index, lung injury score, mechanical ventilation duration
MeSH terms: Blood Pressure, Diuretics, Ethnicity, Female, Fluid Therapy, Furosemide, Hemodynamics, Humans, Intensive Care Units, Male, Middle Aged, Respiration, Artificial, Respiratory Distress Syndrome, Respiratory Function Tests, Water-Electrolyte Balance, Survival Analysis, Treatment Outcome

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Comparison of Two Fluid-Management Strategies in Acute Lung Injury

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