Description of Fluid Balance in Patients With Acute Respiratory Failure

Disruption of fluid balance is common in critical illness. Many critical illnesses are
inflammatory in nature and associated with capillary leak and swelling of tissues. While
fluid administration may be necessary for the immediate resuscitation of a patient in shock,
in the long term it may worsen survival and lead to complications. This is especially true
in acute respiratory failure, where excess fluid can lead to a longer duration of mechanical
ventilation, longer time in the ICU, and a greater need for dialysis. There is also evidence
that conservative fluid administration can prevent complications. Fluid overload is
associated with increased healthcare resource utilization and cost.

Much of the fluid administered to patients while in the adult ICU in the United States is
administered as medications via large volume infusion pumps. This is a descriptive study to
gather data on fluid balance, intravenous medication administration, electrolyte balance,
and diuretic and dialysis use in patients with acute respiratory failure who might benefit
from a strategy designed to limit fluid administration. The information will be used to
design an interventional trial of small volume medication infusion.

Inclusion Criteria:

- Intubation and mechanical ventilation for ≤ 7 days

- An underlying condition associated with acute respiratory failure (e.g. pneumonia,
ARDS, sepsis, asthma, COPD exacerbation)

- If in shock (MAP < 60, fluid bolus ≥30 ml/Kg or 4 L crystalloid or equivalent,
vasopressors except for dopamine ≤ 5 mcg/kg/min or low-dose (≤ 0.04 IU/min)
vasopressin) there should be no fluid bolus (1000 mL crystalloid or equivalent) for
at least 12 hours

Exclusion Criteria:

- Intubation or mechanical ventilation for > 7 days

- Respiratory failure (requirement for positive pressure ventilation) in past 30 days

- Shock (MAP < 60, fluid bolus ≥30 ml/Kg or 4 L crystalloid or equivalent, vasopressors
except for dopamine ≤ 5 mcg/kg/min or low-dose vasopressin) requiring fluid bolus
(1000 mL crystalloid or equivalent) within past 12 hours

- Presence of a condition making it unlikely that the patient will be liberated from
mechanical ventilation within the next 28 days (e.g. quadriplegia, end-stage lung
disease, massive stroke, etc.)

- Prognosis from underlying condition ≤ 28 days (estimated 28 day mortality from
underlying condition >50%)

- Likely intention (>50% probability) to withhold or withdraw life-supportive care
within next 28 days