Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients - insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis

PRoVENT-COVID Study Collaborative Group* ‘PRactice of VENTilation in COVID–19’

doi:10.1186/s13054-022-04023-y

Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients - insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis

PRoVENT-COVID Study Collaborative Group* ‘PRactice of VENTilation in COVID–19’

Research output: Contribution to journal › Article › Academic › peer-review

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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' 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 L (1.27-7.72 L), 0.78 L (0.26-1.27 L), and - 0.35 L (- 6.52-0.26 L), respectively. Higher day 3 cumulative fluid balance was significantly associated with a lower probability of successful ventilation liberation (adjusted hazard ratio 0.86, 95% CI 0.77-0.95, P = 0.0047). 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.

Original language	English
Article number	157
Number of pages	12
Journal	Critical Care
Volume	26
DOIs	https://doi.org/10.1186/s13054-022-04023-y
Publication status	Published - 1 Jun 2022

Funding

*PRoVENT-COVID Collaborative Group. Investigators: (in alphabetic order): S. Ahuja1; J.P. van Akkeren2; A.G. Algera3; C.K. Algoe3; R.B. van Amstel3; A. Artigas4; O.L. Baur3; P. van de Berg5; A.E. van den Berg6; D.C.J.J. Bergmans7; D.I. van den Bersselaar3; F.A. Bertens3; A.J.G.H. Bindels5; M.M. de Boer3; S. den Boer8; L.S. Boers3; M. Bogerd3; L.D.J. Bos3; M. Botta3; J.S. Breel9; H. de Bruin3; S. de Bruin3; C.L. Bruna3; L.A. Buiteman–Kruizinga10; O. L. Cremer11; R.M. Determann12; W. Dieperink13; D.A. Dongelmans3; H.S. Franke13; M.S. Galek-Aldridge3; M.J. de Graaff14; L.A. Hagens3; J.J. Haringman16; S.T. van der Heide3; P.L.J. van der Heiden10; N.F.L. Heijnen15; S.J.P. Hiel2; L.L. Hoeijmakers3; L. Hol3,9; M.W. Hollmann9; M.E. Hoogendoorn16; J. Horn3; R. van der Horst17; E.L.K. Ie3; D. Ivanov3; N.P. Juffermans12; E. Kho3; E.S. de Klerk9; A.W.M.M. Koopman-van Gemert18; M. Koopmans12; S. Kucukcelebi3; M.A. Kuiper19; D.W. de Lange11; N. van Mourik3; S.G. Nijbroek3,9; M. Onrust13; E.A.N. Oostdijk20; F. Paulus3,21; C.J. Pennartz3; J. Pillay3,13; L. Pisani3; I.M. Purmer6; T.C.D. Rettig22; J.P. Roozeman3; M.T.U. Schuijt3; M.J. Schultz3,23,24; A. Serpa Neto25; M.E. Sleeswijk26; M.R. Smit3; P.E. Spronk27; W. Stilma3; A.C. Strang28; A.M. Tsonas3; P.R. Tuinman29; C.M.A. Valk3; F.L. Veen-Schra16; L.I. Veldhuis3; P. van Velzen30; W.H. van der Ven9; A.P.J. Vlaar3; P. van Vliet31; P.H.J. van der Voort13; L. van Welie32; H.J.F.T. Wesselink16; H.H. van der Wier-Lubbers16; B. van Wijk3; T. Winters3; W.Y. Wong3; A.R.H. van Zanten32. Institutional and Departmental Affiliations:1Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health, Detroit, Michigan, United States;2Department of Intensive Care, Maxima Medical Center, Eindhoven, The Netherlands;3Department of Intensive Care, Amsterdam University Medical Centers, location ‘Academic Medical Center,’ Amsterdam, The Netherlands;4Critical Care Center, Sabadell Hospital, Sabadell, Spain;5Department of Intensive Care, Catharina Hospital, Eindhoven, The Netherlands;6Department of Intensive Care, Haga Hospital, the Hague, The Netherlands;7Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands;8Department of Intensive Care, Spaarne Hospital, Haarlem, The Netherlands;9Department of Anaesthesiology, Amsterdam University Medical Centers, location ‘Academic Medical Center,’ Amsterdam, The Netherlands;10Department of Intensive Care, Reinier de Graaf Hospital, Delft, The Netherlands;11Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands;12Department of Intensive Care, OLVG Hospital, location East, Amsterdam, The Netherlands;13Department of Intensive Care, University Medical Center Groningen, Groningen, The Netherlands;14Department of Intensive Care, Sint Antonius Hospital, Nieuwegein, The Netherlands;15Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands;16Department of Intensive Care, Isala Hospital, Zwolle, The Netherlands;17Department of Intensive Care; Zuyderland Hospital, Heerlen and Sittard, The Netherlands;18Department of Intensive Care ZGT Hospital, Almelo, The Netherlands;19Department of Intensive Care Medical Center Leeuwarden, Leeuwarden, The Netherlands;20Department of Intensive Care; Maasstad Hospital, Rotterdam, The Netherlands;21ACHIEVE, Center of Applied Research Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, The Netherlands;22Department of Intensive Care Amphia Hospital, Breda, The Netherlands;23Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand;24Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom;25Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Center (ANZIC-RC), Monash University, Melbourne, Australia;26Department of Intensive Care, FlevoHospital, Almere, The Netherlands;27Department of Intensive Care, Gelre Hospital, Apeldoorn and Zutphen, The Netherlands:;28Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands;29Department of Intensive Care, Amsterdam University Medical Centers, location ‘VU Medical Center,’ Amsterdam, The Netherlands;30Department of Intensive Care, Dijklander Hospital, location Hoorn, Hoorn, The Netherlands;31Department of Intensive Care Haaglanden Medical Center, location Westeinde, the Hague, The Netherlands;32Department of Intensive Care Gelderse Vallei Hospital, Ede, The Netherlands.

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PRoVENT-COVID Study Collaborative Group* ‘PRactice of VENTilation in COVID–19’ (2022). Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients - insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis. Critical Care, 26, Article 157. https://doi.org/10.1186/s13054-022-04023-y

@article{dd5603a455a241c58d86459a68c35509,

title = "Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients - insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis",

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' 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 L (1.27-7.72 L), 0.78 L (0.26-1.27 L), and - 0.35 L (- 6.52-0.26 L), respectively. Higher day 3 cumulative fluid balance was significantly associated with a lower probability of successful ventilation liberation (adjusted hazard ratio 0.86, 95% CI 0.77-0.95, P = 0.0047). 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.",

keywords = "COVID-19/therapy, Cohort Studies, Humans, Noninvasive Ventilation, Respiration, Respiratory Distress Syndrome/therapy, Water-Electrolyte Balance",

author = "{PRoVENT-COVID Study Collaborative Group* {\textquoteleft}PRactice of VENTilation in COVID–19{\textquoteright}} and Sanchit Ahuja and {de Grooth}, Harm-Jan and Frederique Paulus and {van der Ven}, {Fleur L} and {Serpa Neto}, Ary and Schultz, {Marcus J} and Tuinman, {Pieter R}",

note = "{\textcopyright} 2022. The Author(s).",

year = "2022",

month = jun,

day = "1",

doi = "10.1186/s13054-022-04023-y",

language = "English",

volume = "26",

journal = "Critical Care",

issn = "1364-8535",

publisher = "BioMed Central Ltd.",

}

PRoVENT-COVID Study Collaborative Group* ‘PRactice of VENTilation in COVID–19’ 2022, 'Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients - insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis', Critical Care, vol. 26, 157. https://doi.org/10.1186/s13054-022-04023-y

Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients - insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis. / PRoVENT-COVID Study Collaborative Group* ‘PRactice of VENTilation in COVID–19’.
In: Critical Care, Vol. 26, 157, 01.06.2022.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients - insights from the PRoVENT-COVID study

T2 - a national, multicenter, observational cohort analysis

AU - PRoVENT-COVID Study Collaborative Group ‘PRactice of VENTilation in COVID–19’

AU - Ahuja, Sanchit

AU - de Grooth, Harm-Jan

AU - Paulus, Frederique

AU - van der Ven, Fleur L

AU - Serpa Neto, Ary

AU - Schultz, Marcus J

AU - Tuinman, Pieter R

PY - 2022/6/1

Y1 - 2022/6/1

N2 - 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' 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 L (1.27-7.72 L), 0.78 L (0.26-1.27 L), and - 0.35 L (- 6.52-0.26 L), respectively. Higher day 3 cumulative fluid balance was significantly associated with a lower probability of successful ventilation liberation (adjusted hazard ratio 0.86, 95% CI 0.77-0.95, P = 0.0047). 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.

AB - 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' 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 L (1.27-7.72 L), 0.78 L (0.26-1.27 L), and - 0.35 L (- 6.52-0.26 L), respectively. Higher day 3 cumulative fluid balance was significantly associated with a lower probability of successful ventilation liberation (adjusted hazard ratio 0.86, 95% CI 0.77-0.95, P = 0.0047). 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.

KW - COVID-19/therapy

KW - Cohort Studies

KW - Humans

KW - Noninvasive Ventilation

KW - Respiration

KW - Respiratory Distress Syndrome/therapy

KW - Water-Electrolyte Balance

U2 - 10.1186/s13054-022-04023-y

DO - 10.1186/s13054-022-04023-y

M3 - Article

C2 - 35650616

SN - 1364-8535

VL - 26

JO - Critical Care

JF - Critical Care

M1 - 157

ER -

PRoVENT-COVID Study Collaborative Group* ‘PRactice of VENTilation in COVID–19’. Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients - insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis. Critical Care. 2022 Jun 1;26:157. doi: 10.1186/s13054-022-04023-y