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Intensive Care Medicine pp 193–202Cite as

Fluid Management in Acute Lung Injury and ARDS

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Abstract

The ventilatory treatment of acute respiratory distress syndrome (ARDS) has greatly improved in recent years. During the same period, numerous non-ventilatory therapies have been evaluated — some promising, others disappointing in their physiological effects and outcome. Among them, modulation of fluid state and of plasma oncotic pressure has been the object of studies in patients. ARDS is particularly characterized by pulmonary edema owing to an increase in pulmonary capillary permeability. In the early phase of ARDS, an associated septic state is usually responsible for hypovolemia. At this stage, hemodynamic optimization by early and adapted filling has proved to have prognostic value [1] and a fluid restriction strategy can result in hemodynamic aggravation and dysfunction of associated organs, determining the mortality of patients presenting with ARDS [2]. Subsequently, hemodynamic stabilization is generally associated with a resumption of diuresis and a decrease in body weight. Passage from one phase to another is often complex and difficult to distinguish but it is probably by identifying the transition between these two phases that one can detect the moment when a strategy of optimization of fluid balance on the restrictive side is possible. After a review of the physiopathologic bases, this chapter will present the principal clinical studies that have made it possible to advance in the optimization of the fluid state during ARDS.

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Author information

Authors and Affiliations

  1. Medical Intensive Care, Hôpital Sainte-Marguerite, 270 Bd de Sainte Marguerite, 13009, Marseille, France

    A. Roch, C. Guervilly & L. Papazian

Authors
  1. A. Roch
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  2. C. Guervilly
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  3. L. Papazian
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Editor information

Editors and Affiliations

  1. Department of Intensive Care Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium

    Jean-Louis Vincent MD, PhD, FCCM, FCCP (Head) (Head)

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Roch, A., Guervilly, C., Papazian, L. (2010). Fluid Management in Acute Lung Injury and ARDS. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-5562-3_19

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  • DOI: https://doi.org/10.1007/978-1-4419-5562-3_19

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-5561-6

  • Online ISBN: 978-1-4419-5562-3

  • eBook Packages: MedicineMedicine (R0)

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