Fluid overload is associated with increased mortality in adult patients with acute respiratory distress syndrome. In patients requiring venovenous extracorporeal membrane oxygenation (VV-ECMO), the effects of fluid removal on survival and lung recovery remain undefined. We assessed the impact of early fluid removal in adult patients supported by VV-ECMO and concomitant continuous renal replacement therapy, in an 18-bed tertiary intensive care unit between 2010 and 2015. Twenty-four patients met inclusion criteria, of these 15 (63%) survived to hospital discharge. In our patient group, a more negative cumulative daily fluid balance was strongly associated with improved pulmonary compliance (2.72 ml/cmH2O per 1 L negative fluid balance; 95% confidence interval [CI]: 1.61–3.83; P < 0.001). In addition, a more negative mean daily fluid balance was associated with improved pulmonary compliance (4.37 ml/cmH2O per 1 L negative fluid balance; 95% CI: 2.62–6.13; P < 0.001). Survivors were younger and had lower mean daily fluid balance (−0.33 L [95% CI: −1.22 to −0.06] vs. −0.07 L [95% CI: −0.76 to 0.06]; P = 0.438) and lower cumulative fluid balance up to day 14 (−4.60 L [95% CI: −8.40 to −1.45] vs. −1.00 L [95% CI: −4.60 to 0.90]; P = 0.325), although the fluid balance effect alone did not reach statistical significance.
From the *Department of Critical Care Medicine, Mater Misericordiae University Hospital, Dublin
†Department of Intensive Care Medicine, St Vincent’s Hospital, Sydney, Australia.
Submitted for consideration November 2017; accepted for publication in revised form May 2018.
Disclosure: The authors have no conflicts of interest to report.
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Correspondence: Peter McCanny, Department of Intensive Care Medicine, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland. Email: firstname.lastname@example.org.