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Ahuja S, de Grooth HJ, Paulus F, van der Ven FL, Serpa Neto A, Schultz MJ, Tuinman PR, COVID PR-CSCGPoVi: 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. Crit Care 2022; 26: 157

November 22, 2022

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 inter‑ national 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), respec‑ tively. Higher day 3 cumulative fluid balance was significantly associated with a lower probability of successful ventila‑ tion 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 bal‑ ance was associated with a longer ventilation duration, indicating that restricted fluid management in these patients may be beneficial.