الفهرس 
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Abstract
Acute respiratory distress syndrome (ARDS) is a frequent disease that affects up to 23% of mechanically ventilated patients over the course of the ICU stay. Fluid management is a complex issue, and one of the most challenging aspects of patient care. It has long been known that critically ill patients have difficulty maintaining fluid balance. Fluid balance has been shown to improve respiratory physiology for ARDS patients. Static indices, including central venous and pulmonary capillary wedge pressure, are conventionally employed to evaluate volume conditions in patients. However, several studies showed that these indices cannot accurately predict fluid responsiveness. In contrast, dynamic indices, such as systolic pressure variation (SPV), pulse pressure variation (PPV), stroke volume variation (SVV), and pleth variability index (PVI), are well known to be good predictors of fluid responsiveness in mechanically ventilated patients. Among these indices, SVV has been shown to be reliable in assessment of volume status in critically ill patients. A novel noninvasive method of measuring cardiac output is thoracic bioreactance. Electrical Cardiometry is a method for determination of stroke volume (SV), cardiac output (CO), and other hemodynamic parameters in adults, children, and neonates. The applications of cardiometry are advanced non-invasive hemodynamic monitoring, goal-directed therapy and fluid management in the OR, ICU and ED, differential diagnosis of shock, heart failure and hypertension management and pacemaker optimization. Fluid and Catheter Treatment Trial (FACTT Lite) approach, fluid intake is restricted, and urinary output is increased in an attempt to decrease lung edema, shorten the duration of mechanical ventilation, and improve survival. A possible risk of this approach is a decrease in cardiac output and worsening of non-pulmonary-organ function. The aim of this study was to compare the fluid management in acute respiratory distress syndrome ARDS guided by electrical cardiometry (EC) versus the guidance with simplified conservative fluid protocol, Fluid and Catheter Treatment Trial “FACTT Lite”. The primary outcome was 28th day mortality, the secondary outcomes were lung injury score, duration of mechanical ventilation and ICU stay and weaning categories and the safety outcome was organ/s failure. This prospective randomized study was carried out in Tanta University Hospital at surgical intensive care unit (SICU) on 70 patients who were 18 years or older and fulfill the Berlin definition of ARDS. The enrolled patients were randomly allocated into two equal groups according to plan for fluid management of ARDS into: group A (n= 35): Fluid management in this group followed a simplified conservative fluid protocol, “FACTT Lite” and group B (n= 35) Fluid management in this group guided by electrical cardiometry. The summary of our results: 1- The comparison shows insignificant differences between both groups as regard the age, BMI, sex and cause of ARDS. 2- Mortality at 28d was higher in group A than group B (14 (40%) vs 6 (17.1%); P = 0.043). Duration of survival was higher in group B than group A (P = 0.021). Hazardous ratio of mortality in group A was 2.55 times (95% CI: 1.18 - 5.52) than group B. 3- Severity of ARDS was insignificantly different between both groups (P = 0.615). 4- ICU stay and duration of MV were significantly increased in group A compared to group B (P = 0.027 and 0.003). 5- Weaning categories were significantly different between both groups; worse in group A (P = 0.003). 6- MV free days showed an insignificant difference between both groups (P = 0.809). 7- In group A, there was insignificant difference in Lung injury score (LIS) at all time measurements except at 2 days, it showed significant increase compared to the baseline (P = 0.040) and at 21 days, it showed significant decrease compared to the baseline (P = 0.013). In group B, there was insignificant difference in LIS at all time measurements except at 4, 5, 6, 7 and 14 days, it showed significant decrease compared to the baseline (P = 0.017, 0.001, <0.001, <0.001 and <0.001 respectively). There was insignificant difference between both groups in LIS at baseline, 12h, 1, 2 and 3 days but at 4, 5, 6, 7 and 14 days, it showed significant decrease in group B than group A (P = 0.034, 0.021, 0.011, 0.016 and 0.001). 8- In group A, there was insignificant difference in intravenous fluid intake at 2 days compared to the baseline (P = 0.790) but at 3, 4, 5, 6 and 7 days, it showed significant decrease compared to baseline (P <0.001). In group B, there was insignificant difference in intravenous fluid intake at 2 days compared to the baseline (P = 0.252) but at 3, 4, 5, 6 and 7 days, it showed significant decrease compared to baseline (P <0.001). There was significant decrease in group B than group A at all time measurements as regard intravenous fluid intake (P <0.001, <0.001, 0.001, 0.030, 0.017, 0.010 and 0.022). 9- In group A, there was an insignificant difference in UOP at 2 days compared to the baseline (P = 0.616) but at 3, 4, 5, 6 and 7 days, it showed significant decrease compared to the baseline (P <0.001). In group B, there was an insignificant difference in UOP at 2 days compared to the baseline (P = 0.187) but at 3, 4, 5, 6 and 7 days, it showed significant decrease compared to the baseline (P <0.001). There was significant increase in group A compared to group B at all time measurements as regard UOP (P <0.001). 10- There were insignificant differences as regard hemodynamic instability, renal failure, heart failure, sepsis and arrythmia (P = 0.11, 0.493, 0.673, 1 and 0.239 respectively).