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
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’, Sanchit Ahuja, J.P. van Akkeren, Anna Geke Algera, C.K. Algoe, Rombout B. E. van Amstel, Antonio Artigas, O Baur, P. van de Berg, A.E. van den Berg, D. C. J. J. Bergmans, D.I. van den Bersselaar, F.A. Bertens, Alexander J. G. H. Bindels, M.M. de Boer, Sylvia den Boer, L.S. Boers, Margriet Bogerd, Lieuwe D. J. Bos, Michela Botta, Jennifer S. Breel, H. de Bruin, Sanne de Bruin, C.L. Bruna, Laura A. Buiteman‐Kruizinga, Olaf L. Cremer, R.M. Determann, Willem Dieperink, Dave A. Dongelmans, H.S. Franke, Michał S. Gałek-Aldridge, Mart J. de Graaff, Laura A. Hagens, Jasper J. Haringman, S.T. van der Heide, Pim L. J. van der Heiden, Nanon F. L. Heijnen, S.J.P. Hiel, Lotte Hoeijmakers, Liselotte Hol, M.W. Hollmann, Marga Hoogendoorn, Janneke Horn, R. van der Horst, E.L.K. Ie, D. Ivanov, Nicole P. Juffermans, Eline Kho, Eline S. de Klerk, A.W.M.M. Koopman-van Gemert, Matty Koopmans, Songul Kucukcelebi, Michaël Kuiper, Dylan W. de Lange, Niels van Mourik, Sunny G. L. H. Nijbroek, Marisa Onrust, Evelien Oostdijk, Frederique Paulus, C.J. Pennartz, Janesh Pillay, Luigi Pisani, Ilse M. Purmer, Thijs C. D. Rettig, J. P. Roozeman, M.T.U. Schuijt, Marcus J. Schultz, Ary Serpa Neto, M. E. Sleeswijk, Marry R. Smit, Peter E. Spronk, Willemke Stilma, Aart C. Strang, Anissa M. Tsonas, Pieter R. Tuinman, Christel M. A. Valk, F.L. Veen-Schra, Lars I. Veldhuis, Patricia van Velzen, Ward H. van der Ven, Alexander P. J. Vlaar, P. van Vliet, Peter H. J. van der Voort, L. van Welie, H.J.F.T. Wesselink, H.H. van der Wier-Lubbers, B. van Wijk, Tineke Winters, Wing Yi Wong, Arthur R. H. van Zanten
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.