In acute respiratory distress syndrome (ARDS), increased pulmonary vascular permeability makes the lung vulnerable to edema. The use of conservative as compared to liberal fluid strategies may increase the number of ventilator-free days and survival, as well as reduce organ dysfunction. Monitoring the effects of fluid administration is of the utmost importance; dynamic indexes, such as stroke volume and pulse pressure variations, outperform static ones, such as the central venous pressure. The passive leg raise and end-expiratory occlusion tests are recommended for guiding fluid management decisions. The type of intravenous fluids should also be taken into consideration: crystalloids, colloids, and human albumin have all been used for fluid resuscitation. Recent studies have also shown differences in outcome between balanced and non-balanced intravenous solutions. In preclinical studies, infusion of albumin promotes maintenance of the glycocalyx layer, reduces inflammation, and improves alveolar-capillary membrane permeability. Fluids in ARDS must be administered cautiously, considering hemodynamic and perfusion status, oncotic and hydrostatic pressures, ARDS severity, fluid type, volume and infusion rate, and cardiac and renal function. Of note, no guideline to date has recommended a specific fluid composition for use in ARDS; most physicians currently follow recommendations for sepsis.

中文翻译：

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ARDS 中的液体：利大于弊

在急性呼吸窘迫综合征 (ARDS) 中，肺血管通透性增加使肺容易出现水肿。与宽松的液体策略相比，使用保守的液体策略可能会增加无呼吸机的天数和存活率，并减少器官功能障碍。监测输液的效果至关重要；动态指标，如每搏量和脉压变化，优于静态指标，如中心静脉压。建议使用被动抬腿和呼气末闭塞测试来指导液体管理决策。还应考虑静脉输液的类型：晶体液、胶体和人白蛋白均已用于液体复苏。最近的研究还表明平衡和非平衡静脉内溶液的结果存在差异。在临床前研究中，白蛋白的输注促进了糖萼层的维持，减少了炎症，并改善了肺泡 - 毛细血管膜的通透性。ARDS 患者的输液必须谨慎，考虑到血流动力学和灌注状态、渗透压和静水压、ARDS 严重程度、输液类型、容量和输注速度，以及心肾功能。值得注意的是，迄今为止还没有任何指南推荐用于 ARDS 的特定液体成分；大多数医生目前遵循败血症的建议。ARDS 患者的输液必须谨慎，考虑到血流动力学和灌注状态、渗透压和静水压、ARDS 严重程度、输液类型、容量和输注速度，以及心肾功能。值得注意的是，迄今为止还没有任何指南推荐用于 ARDS 的特定液体成分；大多数医生目前遵循败血症的建议。ARDS 患者的输液必须谨慎，考虑到血流动力学和灌注状态、渗透压和静水压、ARDS 严重程度、输液类型、容量和输注速度，以及心肾功能。值得注意的是，迄今为止还没有任何指南推荐用于 ARDS 的特定液体成分；大多数医生目前遵循败血症的建议。