Association of Fluid Management with Outcome in Invasively Ventilated COVID–19 ARDS Patients – Insights From the PRoVENT-COVID Study: A National, Multicenter, Observational Cohort Analysis. (preprint)

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’ (PRoVENT-COVID) 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 liters (1.27-7.72 liter), 0.78 liter (0.26-1.27 liter) and –0.35 liter (–6.52-0.26 liter), respectively. Higher day 3 cumulative fluid balance was significantly associated with a lower probability of successful ventilation liberation (adjusted hazard ratio 0.85, 95% CI 0.77-0.94, P = 0.0013). 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