Effect of fluid balance on alveolar-arterial oxygen gradient in mechanically ventilated patients

Fluid balance affects outcome in critically ill patients. We studied the effect of fluid balance on oxygen exchange by assessing alveolar-arterial oxygen gradient (PA-a O2) in mechanically ventilated patients. Our primary objective was to evaluate the difference in PA-aO2 and the secondary goal was to evaluate the differences in age and mortality rate.

This retrospective observational study was performed on patients who were admitted to medical and surgical ICUs of Sari Imam Hospital, Mazandaran University of Medical Sciences, from 2003 to 2009. Daily fluid balance was calculated by input minus output. Thirty patients with continuous positive fluid balance (PFB) and 30 subjects with continuous negative fluid balance (NFB) during 4 consecutive days were enrolled in this study. PA-a O2 was calculated in these two groups.

The mean (±SD) age was 48.9±21.2 yrs. in PFB group (19 males and 11 females) and 37.1±15.7 yrs. in NFB group (25 males and 5 females) which showed a statistically significant difference in age between the two groups (p = 0.017). The 24h, 48h, and 96h fluid balances were 1226(cc)±881, 1311(cc)±751, and 957(cc)±661 in PFB group and -1122(cc)±692, -920(cc)±394, and -1164(cc)±695 in NFB group, respectively. The mean differences (±SD) of PA-a O2 in 24h, 48h, and 96h versus the same value in the admission day were 11.3±39.2, 1.69±51.1, and -1.50±64 in PFB subjects and -21.8±60.8, -27.8±84.9, and -19.3±68.7 in NFB patients. The difference was statistically significant only in the first day of admission (p = 0.015). However, no difference was detected in overall mean oxygen gradient during 96h among the two groups. Mortality rate was significantly higher in PFB patients (P < 0.0001).

Positive fluid balance had no significant effect on PA-a O2 but can be used as a predictor of mortality.