Fluid management in acute lung injury and ARDS

Abstract

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) continue to be major causes of morbidity and mortality in the ICU due to a lack of specific, effective therapy. Affecting approximately 200,000 people every year in the United States alone, patients with this syndrome often require extensive ICU and hospital care. This leads to enormous utilization of healthcare resources and significant expenditures, and ultimately leaves survivors with a reduced quality of life. ALI/ARDS is a disease of altered capillary permeability characterized by significant fluid imbalances and oncotic pressure changes. Although investigations directed at these abnormalities may improve patient-centred outcomes, fluid management in ALI/ARDS continues to be a source of great controversy. In this article, we discuss fluid balance and the colloid osmotic pressure gradients in ALI/ARDS, followed by a review of the prognostic implications of increasing extravascular lung water. We conclude with contemporary approaches to optimizing therapy in this condition, including the role of albumin and diuretic therapy. © 2012, Nederlandse Vereniging voor Intensive Care. All Rights Reserved.