• Andrew L Rosenberg, Ronald E Dechert, Pauline K Park, Robert H Bartlett, and NIH NHLBI ARDS Network.
• Departments of Anesthesiology and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA. arosen@med.umich.edu
• J Intensive Care Med. 2009 Jan 1;24(1):35-46.

ObjectiveTo evaluate the independent influence of fluid balance on outcomes for patients with acute lung injury.DesignSecondary analysis of a prospective cohort study conducted between March 1996 and March 1999.SettingThe study involved 10 academic clinical centers (with 24 hospitals and 75 Intensive Care Units).PatientsAll patients for whom fluid balance data existed (844) from the 902 patients enrolled in the National Heart Lung Blood Institute's ARDS Network ventilator-tidal volume trial.InterventionsThe study had no interventions.Measurements/ResultsOn the first day of study enrollment, 683 patients were, on average, more than 3.5 L in positive fluid balance compared to 161 patients in negative fluid balance (P < .001). Cumulative negative fluid balance on day 4 of the study was associated with an independently lower hospital mortality (OR, 0.50; 95% CI, 0.28-0.89; P < .001) more ventilator and intensive care unit-free days.ConclusionsNegative cumulative fluid balance at day 4 of acute lung injury is associated with significantly lower mortality, independent of other measures of severity of illness.

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