Fluids in acute respiratory distress syndrome: pros and cons

PURPOSE OF REVIEW: Fluid resuscitation in acute respiratory distress syndrome (ARDS) is not well documented. Clinical evidence comes from studies in critically ill patients, but these patients respond differently to fluids depending on the presence or absence of sepsis. RECENT FINDINGS: Clinical trials have shown adverse effects on kidney and hemostatic functions and trends toward increased mortality after hydroxyethyl starch infusion. Although well conducted, the methodology deserves attention concerning the infused volume, hemodynamic goals and the presence of septic and nonseptic patients. Small single-center studies have shown beneficial results associated with colloidal molecules through innovative methodological apparatus. Ongoing clinical trials allied to retrospective and prospective trials may favor the introduction of albumin in the critically ill population. SUMMARY: In order to evaluate the pros and cons of using fluids in ARDS patients, it is important to carefully analyze the latest trials. Recent studies have emphasized the importance of better understanding endothelial pathophysiology during fluid management in ARDS patients. Certainly, further studies analyzing fluid strategies in septic and nonseptic ARDS patients are needed.