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Conservative Tactics Best in Lung Injury Fluid Management

Strategy improves lung function and shortens time on mechanical ventilation

MONDAY, May 22 (HealthDay News) -- In patients with acute lung injury, a conservative strategy of fluid management, in which fluid intake is restricted and urinary output is increased, appears to be better than a strategy involving liberal fluid intake, according to a study published online May 21 in the New England Journal of Medicine. The findings were released early to coincide with their presentation at the International Conference of the American Thoracic Society in San Diego.

Herbert P. Wiedemann, M.D., of the Cleveland Clinic in Ohio, and colleagues compared the two strategies in 1,000 patients. The death rate at 60 days was similar in the two groups: 25.5 percent in the patients treated using the conservative strategy and 28.4 percent in those treated using the liberal strategy. However, during the first 28 days, the conservative strategy improved lung function, cut the time on mechanical ventilation and shortened intensive care stays without heightening the risk of non-pulmonary-organ failures.

"Use of a conservative fluid-management protocol with a lower central venous pressure or pulmonary-artery occlusion pressure target resulted in a major reduction in net fluid balance without an increase in adverse events, as compared with a liberal fluid-management protocol targeting higher intravascular filling pressures," the authors write.

An accompanying editorial notes that each strategy may have an appropriate place, with conservative fluid management being useful during the established phase of acute lung injury, and titrated liberal administration of fluids being useful during the acute phase of the inciting insult.

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