Observational studyPloS one2019
Cumulative fluid balance predicts mortality and increases time on mechanical ventilation in ARDS patients: An observational cohort study.
Observational study in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07438015 (VEXUS-REA), which is not on this map. Cited by 58 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
VEXUS-REA : Evaluation of Ultrasound Parameters of Venous Congestion in Patients in a Medical Intensive Care Unit
Who cites it
58 citing papers in PubMed, 2 syntheses or guidelines pooled it, 103 citations in OpenAlex.
- European Society of Intensive Care Medicine (ESICM) 2025 clinical practice guideline on fluid therapy in adult critically ill patients: part 2-the volume of resuscitation fluids.Intensive care medicine · 2025Guideline
- New Insights on Continuous Renal Replacement Therapy for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis.The clinical respiratory journal · 2025Pooled it
- Association between fluid balance, muscle strength, and muscle quality in critically ill patients: a retrospective observational study.Intensive care medicine experimental · 2026Article
- Correlation between early cumulative fluid balance and 90-day all-cause mortality in patients with acute pancreatitis: a retrospective cohort study.Clinics (Sao Paulo, Brazil) · 2026Article
- Fluid Balance is Associated with Differential Effects on Respiratory Failure between Critically Ill and Noncritically Ill Adults with SARS-CoV-2: a Retrospective Cohort Study.Shock (Augusta, Ga.) · 2026Article
- Prognostic Impact of Cumulative Fluid Balance in Critically Ill Patients: A Retrospective Cohort Study.Cureus · 2026Article
- Joint trajectories of nutritional risk and fluid balance and prognosis in critically ill adults: a dual-trajectory modeling study using MIMIC-IV and eICU.Frontiers in nutrition · 2026Article
- Association between fluid balance trajectories and prognosis in older patients with malnutrition: a group-based trajectory model analysis.Frontiers in nutrition · 2026Article
- Advances in bedside imaging: lung ultrasound.Intensive care medicine experimental · 2025Review
- Recent updates regarding the management and treatment of pneumonia in pediatric patients: a comprehensive review.Infection · 2025Review
- Management of endothelial dysfunction in septic shock: role of albumin administration.Journal of intensive care · 2025Article
- Article
- A Comprehensive Review of Fluid Resuscitation Strategies in Traumatic Brain Injury.Journal of clinical medicine · 2025Review
- The association of fluid balance with traumatic brain injury outcomes: A systematic review.Journal of intensive medicine · 2025Article
- Fluid management strategies in critically ill patients with ARDS: a narrative review.European journal of medical research · 2025Review
- Excessive fluid resuscitation is associated with intensive care unit mortality in Pakistani patients with dengue shock syndrome.Acute and critical care · 2025Article
- Acute Respiratory Distress Syndrome and Fluid Management: Finding the Perfect Balance.Journal of clinical medicine · 2025Review
- The PROtective VEntilation (PROVE) Network - advancing research and collaboration in mechanical ventilation.Critical care science · 2025Review
- Clinical management of sepsis-associated acute respiratory distress syndrome: current evidence and future directions.Frontiers in medicine · 2025Review
- Fluid responsiveness in acute respiratory distress syndrome patients: a post hoc analysis of the HEMOPRED study.Intensive care medicine · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionAcute respiratory distress syndrome (ARDS) is characterized by acute, diffuse, inflammatory lung injury leading to increased pulmonary vascular permeability, pulmonary oedema and loss of aerated tissue. Previous literature showed that restrictive fluid therapy in ARDS shortens time on mechanical ventilation and length of ICU-stay. However, the effect of intravenous fluid use on mortality remains uncertain. We investigated the relationship between cumulative fluid balance (FB), time on mechanical ventilation and mortality in ARDS patients. MATERIALS AND
methodsRetrospective observational study. Patients were divided in four cohorts based on cumulative FB on day 7 of ICU-admission: ≤0 L (Group I); 0-3.5 L (Group II); 3.5-8 L (Group III) and ≥8 L (Group IV). In addition, we used cumulative FB on day 7 as continuum as a predictor of mortality. Primary outcomes were 28-day mortality and ventilator-free days. Secondary outcomes were 90-day mortality and ICU length of stay.
resultsSix hundred ARDS patients were included, of whom 156 (26%) died within 28 days. Patients with a higher cumulative FB on day 7 had a longer length of ICU-stay and fewer ventilator-free days on day 28. Furthermore, after adjusting for severity of illness, a higher cumulative FB was associated with 28-day mortality (Group II, adjusted OR (aOR) 2.1 [1.0-4.6], p = 0.045; Group III, aOR 3.3 [1.7-7.2], p = 0.001; Group IV, aOR 7.9 [4.0-16.8], p<0.001). Using restricted cubic splines, a non-linear dose-response relationship between cumulative FB and probability of death at day 28 was found; where a more positive FB predicted mortality and a negative FB showed a trend towards survival.
conclusionsA higher cumulative fluid balance is independently associated with increased risk of death, longer time on mechanical ventilation and longer length of ICU-stay in patients with ARDS. This underlines the importance of implementing restrictive fluid therapy in ARDS patients.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.