Restrictive Versus Liberal Fluid Guideline to Practice in Acute Respiratory Distress Syndrome Secondary to Sepsis – Reality in a Tertiary Care Center

Objectives: Sepsis is a leading cause of acute respiratory distress syndrome (ARDS) worldwide. Effective fluid management strategies are essential for treating these patients. This research assesses the practical implementation and outcomes of restrictive versus liberal fluid management approaches in ARDS caused by sepsis. The aim of the study is to assess the clinical outcomes linked to various fluid management strategies in real-world scenarios, providing insights to optimize clinical practices and develop personalized treatment protocols for very sick patients with ARDS. Material and Methods: This retrospective observational study included 120 patients with ARDS due to sepsis. They were treated at a tertiary care center in India between June 2022 and January 2024. Patients were categorized into restrictive fluid groups (RGs) and liberal fluid groups (LGs). 28-day mortality was considered the primary outcome, while the secondary outcomes included the period of ventilatory support, intensive care unit (ICU) length of stay, incidence of renal failure, need for renal replacement therapy (RRT), and new organ dysfunction. Results: Patients in the RG had a significant decline in 28-day mortality (25% vs. 40%, P = 0.043) and shorter period of ventilatory support (8 days vs. 12 days, P = 0.001) compared to the LG. ICU length of stay was also reduced (12 days vs. 16 days, P = 0.028). The incidence of renal failure or need for RRT was insignificant between groups. However, the incidence of new organ dysfunction was significant between groups. Conclusion: Restrictive fluid management in ARDS resulting from sepsis has been linked to better survival rates, shorter periods of mechanical ventilation, and reduced ICU stays. These results advocate for adopting restrictive fluid strategies.