Christopher Coriasso, DO, MS
Critical Care Fellow
Mercy Hospital Saint Louis
Saint Louis, MO, United States
Disclosure information not submitted.
Steve Onyambu, MD
Critical Care Fellow
Mercy Hospital Saint Louis
Saint Louis, United States
Disclosure information not submitted.
Ahmed Alsaei, MD
Mercy Hospital Saint Louis
Saint Louis, Missouri
Disclosure information not submitted.
Muhammad Javed, MD, FCCP, FCCM,FCCM
Associate Program Director
Mercy Hospital Saint Louis
Saint Louis, Missouri, United States
Disclosure information not submitted.
Title: The Effect of Fluid Balance on Mortality in COVID-19 Patients Admitted to the ICU
Introduction: Severe Coronavirus disease 2019 (Covid-19) represents viral pneumonia from severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection leading to ARDS. In ARDS patients, positive fluid balance has been associated with prolonged mechanical ventilation, longer ICU and hospital stay, and higher mortality. As a result, restrictive fluid strategies improved oxygenation significantly and reduced duration of mechanical ventilation. The objective of this study is to evaluate the effect of fluid balance on mortality in patients with COVID-19 admitted to the ICU.
Methods: All data were retrospectively collected from electronic health records of COVID-19 patients admitted to our ICU between March and July, 2020. COVID ARDS patients in our institution are managed based on ARDS management guidelines that include lung protective ventilation strategy, PEEP protocol, and prone positioning for PaO2/FiO2 (P/F) ratio < 150. Fluid balance was calculated on Day 1 (F1) and Day 7 (F7) of ICU admission. Groups were divided into survivors (S) and nonsurvivors (NS) at hospital discharge. Student t test was used to compare means.
Results: A total of 86 patients with COVID-19 were included, with 55 survivors (S) and 31 nonsurvivors (NS); mortality rate of 36%. F1 was similar between S group and NS group (751 +/- 1777 ml vs 441 +/- 1274 ml, p = 0.4). F7 was significantly less for S than NS (- 269 +/- 1354 ml vs 1042 +/- 3451 ml, p = 0.01). [F7 – F1] was also significantly different between S and NS groups (- 960 +/- 2140 ml vs 332 +/- 3165 ml, p = 0.02). P/F improved from 133 +/- 89 on day 1 to 172 +/- 80 on day 7 in S group (p = 0.01). P/F remained the same between day 1 and day 7 in NS group (153 +/- 118 vs 150 +/- 103, p = 0.9).
Conclusions: Restrictive fluid strategy was associated with improved oxygenation and survival in COVID ARDS patients admitted to the ICU. These results support the use of a conservative strategy of fluid management in this patient population. These findings should be investigated in large multicenter prospective studies.