To investigate the effect of noninvasive cardiac output monitoring (NICOM) combined with severe ultrasound in fluid management of patients with acute respiratory distress syndrome (ARDS).

From July 2018 to February 2020, 126 patients with ARDS admitted to Shenzhen University General Hospital were divided into a study group (n = 63) and a control group (n = 63). Traditional hemodynamic monitoring methods were used to guide fluid management in the control group, while in the study group, the NICOM combined with severe ultrasound evaluation were used on the basis of the control group. The general data, furosemide use, fluid intake, fluid output and prognosis were compared between these two groups, as well as the lung injury score, oxygenation index, arterial blood carbon dioxide partial pressure, arterial blood pH value, central venous oxygen saturation, B line count, blood creatinine, blood urea nitrogen, hemoglobin, bicarbonate and blood glucose after 7 days of treatment.

The furosemide use [(47.0 ± 3.5) mg / d vs. (21.6 ± 2.3) mg / d, t = 48.035, P < 0.001], fluid output [(3 332 ± 106) mL / d vs. (2 862 ± 100) mL / d, t = 25.485, P < 0.001], oxygenation index [(327.3 ± 3.5) mmHg vs. (203.4 ± 2.6) mmHg, t = 225.002, P < 0.001], central venous oxygen saturation [(77 ± 22)% vs. (67 ± 19)%, t = 2.847, P = 0.005], hemoglobin [(91.0 ± 1.8) g / L vs. (87.0 ± 1.8) g / L, t = 12.369, P < 0.001], ventilator weaning within 28 d [(15.1 ± 0.5) d vs. (11.5 ± 0.6) d, t = 36.634, P < 0.001] in the study group were significantly higher than those in the control group. The fluid intake [(3 162 ± 90) mL / d vs. (3 837 ± 120) mL / d, t = 35.693, P < 0.001], lung injury score [(2.79 ± 0.30) vs. (4.70 ± 0.20), t = 41.912, P < 0.001], B line count [(9 ± 4) vs. (12 ± 4), t = 4.458, P < 0.001], blood glucose [(7.9 ± 0.3) mmol / L vs. (8.0 ± 0.4) mmol / L, t = 2.758, P = 0.007] and ICU stay [(17.5 ± 1.8) d vs. (21.7 ± 2.3) d, t = 11.435, P < 0.001] in the study group were significantly lower than those in the control group. There were no significant differences in the 28-d mortality [27.0% (17 / 63) vs. 17.5% (11 / 63)] and incidence of organ dysfunction within 28 d [41.3% (26 / 63) vs. 44.4% (28 / 63)] between the control group and study group ( χ² = 1.653, 0.130; P = 0.199, 0.719).

The fluid management of ARDS patients by NICOM combined with severe ultrasound can improve their pulmonary oxygenation, reduce fluid intake and significantly shorten the duration of ICU stay and mechanical ventilation without increasing organ dysfunction, which is worth promotion in clinic.