{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T19:55:41Z","timestamp":1775159741322,"version":"3.50.1"},"reference-count":51,"publisher":"American Physiological Society","issue":"6","funder":[{"name":"Ammodo Foundation"},{"name":"Foundation of Pediatric Intensive Care"}],"content-domain":{"domain":["journals.physiology.org"],"crossmark-restriction":true},"short-container-title":["American Journal of Physiology-Lung Cellular and Molecular Physiology"],"published-print":{"date-parts":[[2021,6,1]]},"abstract":"<jats:p> Intravenous fluids are widely used to treat circulatory deterioration in pediatric acute respiratory distress syndrome (PARDS). However, the accumulation of fluids in the first days of PARDS is associated with adverse outcome. As such, early fluid restriction may prove beneficial, yet the effects of such a fluid strategy on the cardiopulmonary physiology in PARDS are unclear. In this study, we compared the effect of a restrictive with a liberal fluid strategy on a hemodynamic response and the formation of pulmonary edema in an animal model of PARDS. Sixteen mechanically ventilated lambs (2\u20136 wk) received oleic acid infusion to induce PARDS and were randomized to a restrictive or liberal fluid strategy during a 6-h period of mechanical ventilation. Transpulmonary thermodilution determined extravascular lung water (EVLW) and cardiac output (CO). Postmortem lung wet-to-dry weight ratios were obtained by gravimetry. Restricting fluids significantly reduced fluid intake but increased the use of vasopressors among animals with PARDS. Arterial blood pressure was similar between groups, yet CO declined significantly in animals receiving restrictive fluids ( P = 0.005). There was no difference in EVLW over time ( P = 0.111) and lung wet-to-dry weight ratio [6.1, interquartile range (IQR) = 6.0\u20137.3 vs. 7.1, IQR = 6.6\u20139.4, restrictive vs. liberal, P = 0.725] between fluid strategies. Both fluid strategies stabilized blood pressure in this model, yet early fluid restriction abated CO. Early fluid restriction did not limit the formation of pulmonary edema; therefore, this study suggests that in the early phase of PARDS, a restrictive fluid strategy is not beneficial in terms of immediate cardiopulmonary effects. <\/jats:p>","DOI":"10.1152\/ajplung.00613.2020","type":"journal-article","created":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T17:21:36Z","timestamp":1617816096000},"page":"L1126-L1136","update-policy":"https:\/\/doi.org\/10.1152\/aps-crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Early restrictive fluid resuscitation has no clinical advantage in experimental severe pediatric acute respiratory distress syndrome"],"prefix":"10.1152","volume":"320","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6516-9830","authenticated-orcid":true,"given":"Sarah A.","family":"Ingelse","sequence":"first","affiliation":[{"name":"Department of Pediatric Intensive Care, Emma Children\u2019s Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marloes M.","family":"IJland","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8259-2497","authenticated-orcid":true,"given":"Lex M.","family":"van Loon","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands"},{"name":"Cardiovascular and Respiratory Physiology Group, Faculty of Science         and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reinout A.","family":"Bem","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care, Emma Children\u2019s Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Job B. 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