Aiming for a negative fluid balance in patients with acute lung injury and increased intra-abdominal pressure: A pilot study looking at the effects of PAL-treatment

Page hits: 3792, File downloaded: 483

Download file

Download this file

Open in browser

Open this file in your browser


Colin Cordemans, Inneke De Laet, Niels Van Regenmortel, Karen Schoonheydt, Hilde Dits, Greg Martin, Wolfgang Huber, Manu L. N. G. Malbrain



Achievement of a negative fluid balance in patients with capillary leak is associated with improved outcome. We investigated the effects of a multi-modal restrictive fluid strategy aiming for negative fluid balance in patients with acute lung injury (ALI)


In this retrospective matched casecontrol study, we included 114 mechanically ventilated (MV) patients with ALI. We compared outcomes between a group of 57 patients receiving PAL-treatment (PAL group) and a matched control group, abstracted from a historical cohort. PAL-treatment combines high levels of positive end-expiratory pressure, small volume resuscitation with hyperoncotic albumin, and fluid removal with furosemide (Lasix®) or ultrafiltration. Effects on extravascular lung water index (EVLWI), intra-abdominal pressure (IAP), organ function, and vasopressor therapy were recorded during 1 week. The primary outcome parameter was 28-day mortality.


At baseline, no significant intergroup differences were found, except for lower Pa0/FI02 and increased IAP in the PAL group (174.5±84.5 vs 256.5±152.7,p=0.001; 10.0±4.2 vs 8.0±3.7 mmHg, p=0.013, respectively). After 1 week, PAL-treated patients had a greater reduction of EVLWI, IAP, and cumulative fluid balance (-4.2±5.6 vs -1.1 ±3.7 mL/kg, p=0.006; -0.4±3.6 vs 1.8±3.8 mmHg, p=0.007; -1.451±7.761 vs 8.027±5.254 mL,p<0.001). Repercussions on cardiovascular and renal function were limited. PAL-treated patients required fewer days of intensive care unit admission and days on MV (23.6±15 vs 37.1±19.9 days,p=0.006; 14.6±10.7 vs 25.5±20.2 days, respectively) and had a lower 28-day mortality (28.l % vs 49.l %, p=0.034)


PAL-treatment in patients with ALI is associated with a negative fluid balance, a reduction of EVLWI and IAP, and improved clinical outcomes without compromising organ function.

Leave a comment

Please login to leave a comment.

Social Media

  like us on Facebook

  follow us on Twitter

  join Discussion group

  join us on Linkedin

  newsletter sign up

  post on the blog