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Fluid Balance and Recovery of Native Lung Function in Adult Patients Supported by Venovenous Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy

McCanny, Peter*,†; Smith, Myles W.; O’Brien, Serena G.*; Buscher, Hergen; Carton, Edmund G.*

doi: 10.1097/MAT.0000000000000860
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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.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Peter McCanny, Department of Intensive Care Medicine, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland. Email: pjmccanny@gmail.com.

Copyright © 2019 by the American Society for Artificial Internal Organs