Association between cumulative balance and extubation failure in multi-disciplinary intensive care unit, a prospective observational study

A positive cumulative fluid balance is known to be associated with increased mortality in critically ill patients. Studies have shown favorable clinical outcomes by achieving negative fluid balance in the later stage of critical illness. There is a strong biological plausibility to believe that the cumulative fluid balance will have its impact on the respiratory outcome of patients. A positive cumulative fluid balance leads to increased capillary leak, increase in extravascular lung water, and decrease in lung compliance and may result in respiratory failure both during spontaneous breathing trial (SBT) and in the immediate post extubation period. Restrictive fluid strategy has shown to decrease the length of mechanical ventilation, intensive care unit (ICU) length of stay, and a trend toward decreased mortality in patients with acute respiratory distress syndrome. In an earlier study, the relationship between fluid balance and weaning outcome was explored. Both negative fluid balance 24‑h pre-extubation and negative net cumulative balance since intubation were found to be independently associated with successful weaning. However, extensive use of diuretics in the study population and majority of patients achieving negative fluid balance or euvolemia at the first SBT questions the generalizability of the study results.