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Ahuja S, de Grooth HJ, Paulus F, van der Ven FL, Serpa Neto A, Schultz MJ, Tuinman PR, Ahuja S, van Akkeren JP, Algera AG, Algoe CK, van Amstel RB, Artigas A, Baur OL, van de Berg P, van den Berg AE, Bergmans DCJJ, van den Bersselaar DI, Bertens FA, Bindels AJGH, de Boer MM, den Boer S, Boers LS, Bogerd M, Bos LDJ, Botta M, Breel JS, de Bruin H, de Bruin S, Bruna CL, Buiteman-Kruizinga LA, Cremer OL, Determann RM, Dieperink W, Dongelmans DA, Franke HS, Galek-Aldridge MS, de Graaff MJ, Hagens LA, Haringman JJ, van der Heide ST, van der Heiden PLJ, Heijnen NFL, Hiel SJP, Hoeijmakers LL, Hol L, Hollmann MW, Hoogendoorn ME, Horn J, van der Horst R, Ie ELK, Ivanov D, Juffermans NP, Kho E, de Klerk ES, Koopman-van Gemert AWMM, Koopmans M, Kucukcelebi S, Kuiper MA, de Lange DW, van Mourik N, Nijbroek SG, Onrust M, Oostdijk EAN, Paulus F, Pennartz CJ, Pillay J, Pisani L, Purmer IM, Rettig TCD, Roozeman JP, Schuijt MTU, Schultz MJ, Serpa Neto A, Sleeswijk ME, Smit MR, Spronk PE, Stilma W, Strang AC, Tsonas AM, Tuinman PR, Valk CMA, Veen-Schra FL, Veldhuis LI, van Velzen P, van der Ven WH, Vlaar APJ, van Vliet P, van der Voort PHJ, van Welie L, Wesselink HJFT, van der Wier-Lubbers HH, van Wijk B, Winters T, Wong WY, van Zanten ARH. 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. [PMID: 35650616 PMCID: PMC9157033 DOI: 10.1186/s13054-022-04023-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
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
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Botta M, Wenstedt EFE, Tsonas AM, Buiteman-Kruizinga LA, van Meenen DMP, Korsten HHM, Horn J, Paulus F, Bindels AGJH, Schultz MJ, De Bie AJR. Effectiveness, safety and efficacy of INTELLiVENT-adaptive support ventilation, a closed-loop ventilation mode for use in ICU patients - a systematic review. Expert Rev Respir Med 2021; 15:1403-1413. [PMID: 34047244 DOI: 10.1080/17476348.2021.1933450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: INTELLiVENT-Adaptive Support Ventilation (INTELLiVENT-ASV), an advanced closed-loop ventilation mode for use in intensive care unit (ICU) patients, is equipped with algorithms that automatically adjust settings on the basis of physiologic signals and patient's activity. Here we describe its effectiveness, safety, and efficacy in various types of ICU patients.Areas covered: A systematic search conducted in MEDLINE, EMBASE, the Cochrane Central register of Controlled Trials (CENTRAL), and in Google Scholar identified 10 randomized clinical trials.Expert opinion: Studies suggest INTELLiVENT-ASV to be an effective automated mode with regard to the titrations of tidal volume, airway pressure, and oxygen. INTELLiVENT-ASV is as safe as conventional modes. However, thus far studies have not shown INTELLiVENT-ASV to be superior to conventional modes with regard to duration of ventilation and other patient-centered outcomes. Future studies are needed to test its efficacy.
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Affiliation(s)
- M Botta
- Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands
| | - E F E Wenstedt
- Department of Intensive Care, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - A M Tsonas
- Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands
| | - L A Buiteman-Kruizinga
- Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands.,Department of Intensive Care, Reinier de Graaf Hospital, Delft, The Netherlands
| | - D M P van Meenen
- Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands
| | - H H M Korsten
- Department of Intensive Care, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - J Horn
- Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam UMC Research Institute, Amsterdam, The Netherlands
| | - F Paulus
- Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands.,Faculty of Health, ACHIEVE, Centre of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - A G J H Bindels
- Department of Intensive Care, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - M J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands.,Mahidol-Oxford Tropical Research Unit, Mahidol University, Mahidol-Oxford Tropical Medicine Research Unit, Bangkok, Thailand.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - A J R De Bie
- Department of Intensive Care, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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