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Critical Care

Volume 18 Supplement 2

Sepsis 2014

Open Access

Impact of fluid management during the three ICU days after admission in patients with ARDS

  • A Murai1,
  • H Ishikura1,
  • N Matsumoto1,
  • Y Nakamura1,
  • D Ohta1,
  • K Muranishi1,
  • Y Izutani1 and
  • T Nishida1
Critical Care201418(Suppl 2):P25

Published: 3 December 2014


Acute Respiratory Distress SyndromeSequential Organ Failure AssessmentFluid ResuscitationSurvival GroupReferral Hospital


The optimal evaluation of fluid resuscitation in patients with acute respiratory distress syndrome (ARDS) remains to be clearly elucidated. The purpose of this study was to clarify the influence of fluid overload in patients with ARDS.


Two hundred and seven ARDS patients admitted to the ICUs of 23 tertiary referral hospitals in Japan were enrolled in this study. These patients were divided into survivor (survival group, n = 137) or nonsurvivor (nonsurvival group, n = 70) groups according to the 28-day mortality. All patients received mechanical ventilation and also underwent transpulmonary thermodilution monitoring. The data for analysis were collected for three consecutive days from time of admission.


On the second hospital day, the extravascular lung water index of the nonsurvival group was significantly higher than that of the survival group (18.6 ± 9.4 ml/kg vs. 15.4 ± 6.3 ml/kg, P = 0.03). Moreover, regarding the first 3-day cumulative fluid balance, the nonsurvival group was significantly higher than survival group (5.1 ± 4.3 l vs. 3.5 ± 0.4 l, P = 0.015). We suspected that these results might be related to the cardiovascular and/or renal function. We therefore excluded any patients with a score of three or more regarding the cardiovascular and/or renal criteria about the Sequential Organ Failure Assessment score. Thereafter, we confirmed the results to be similar for the first 3-day cumulative fluid balance between the two groups (3.8 ± 1.6 l vs. 2.2 ± 4.0 l, P = 0.0339). A stepwise logistic regression analysis identified the 3-day cumulative fluid balance to be an independent risk factor for the 28-day mortality (adjusted odds ratio: 1.0001, 95% CI: 1.000017 to 1.000217, P = 0.0252).


Our findings suggest that excessive fluid resuscitation may therefore have a negative impact on the 28-day mortality for patients with ARDS.



In this study, we retrospectively analyzed the database of a multicenter observational study (The PiCCO Pulmonary Edema Study).

Authors’ Affiliations

Department of Emergency and Critical Care Medicine, Fukuoka University, Fukuoka, Japan


© Murai et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.