{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T07:08:59Z","timestamp":1793171339950,"version":"4.5.0"},"reference-count":27,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T00:00:00Z","timestamp":1627430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012553","name":"Chang Gung Memorial Hospital","doi-asserted-by":"publisher","award":["CMRPG3K1151"],"award-info":[{"award-number":["CMRPG3K1151"]}],"id":[{"id":"10.13039\/100012553","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Membranes"],"abstract":"<jats:p>Extracorporeal membrane oxygenation (ECMO) is considered a salvage therapy in cases of severe acute respiratory distress syndrome (ARDS) with profound hypoxemia. However, the need for high-volume fluid resuscitation and blood transfusions after ECMO initiation introduces a risk of fluid overload. Positive fluid balance is associated with mortality in critically ill patients, and conservative fluid management for ARDS patients has been shown to shorten both the duration of mechanical ventilation and time spent in intensive care, albeit without a significant effect on survival. Nonetheless, few studies have addressed the influence of fluid balance on clinical outcomes in severe ARDS patients undergoing ECMO. In the current retrospective study, we examined the impact of cumulative fluid balance (CFB) on hospital mortality in 152 cases of severe ARDS treated using ECMO. Overall hospital mortality was 53.3%, and we observed a stepwise positive correlation between CFB and the risk of death. Cox regression models revealed that CFB during the first 3 days of ECMO was independently associated with higher hospital mortality (adjusted hazard ratio 1.110 [95% CI 1.027\u20131.201]; p = 0.009). Our findings indicate the benefits of a conservative treatment approach to avoid fluid overload during the early phase of ECMO when dealing with severe ARDS patients.<\/jats:p>","DOI":"10.3390\/membranes11080567","type":"journal-article","created":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T11:12:52Z","timestamp":1627470772000},"page":"567","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Cumulative Fluid Balance during Extracorporeal Membrane Oxygenation and Mortality in Patients with Acute Respiratory Distress Syndrome"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1660-7715","authenticated-orcid":false,"given":"Li-Chung","family":"Chiu","sequence":"first","affiliation":[{"name":"Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"Department of Thoracic Medicine, New Taipei Municipal TuCheng Hospital and Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Pang","family":"Chuang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7915-0014","authenticated-orcid":false,"given":"Shih-Wei","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Ching","family":"Chiou","sequence":"additional","affiliation":[{"name":"School of Medicine, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsin-Hsien","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan"},{"name":"Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yung-Chang","family":"Chen","sequence":"additional","affiliation":[{"name":"Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Jr","family":"Lin","sequence":"additional","affiliation":[{"name":"Research Services Center for Health Information, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chee-Jen","family":"Chang","sequence":"additional","affiliation":[{"name":"Research Services Center for Health Information, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng-Chun","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7058-6244","authenticated-orcid":false,"given":"Ko-Wei","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han-Chung","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan"},{"name":"Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan"},{"name":"Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung-Chi","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan"},{"name":"Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan"},{"name":"Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaw-Woei","family":"Leu","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8777-1638","authenticated-orcid":false,"given":"Kuo-Chin","family":"Kao","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan"},{"name":"Department of Respiratory Therapy, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan"},{"name":"Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1056\/NEJMct1103720","article-title":"Extracorporeal membrane oxygenation for ARDS in adults","volume":"365","author":"Brodie","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Giani, M., Redaelli, S., Siragusa, A., Fumagalli, B., Rona, R., and Foti, G. (2021). Extracorporeal Gas Exchange for Acute Respiratory Distress Syndrome: Open Questions, Controversies and Future Directions. Membranes, 11.","DOI":"10.3390\/membranes11030172"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/j.chest.2017.06.016","article-title":"Extracorporeal Membrane Oxygenation for Adult Respiratory Failure: 2017 Update","volume":"152","author":"Abrams","year":"2017","journal-title":"Chest"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1164\/rccm.201701-0217CP","article-title":"Fifty Years of Research in ARDS. Is Extracorporeal Circulation the Future of Acute Respiratory Distress Syndrome Management?","volume":"195","author":"Combes","year":"2017","journal-title":"Am. J. Respir Crit. Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1186\/s13054-019-2437-2","article-title":"Extracorporeal gas exchange: When to start and how to end?","volume":"23","author":"Gattinoni","year":"2019","journal-title":"Crit. Care"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Ficial, B., Vasques, F., Zhang, J., Whebell, S., Slattery, M., Lamas, T., Daly, K., Agnew, N., and Camporota, L. (2021). Physiological Basis of Extracorporeal Membrane Oxygenation and Extracorporeal Carbon Dioxide Removal in Respiratory Failure. Membranes, 11.","DOI":"10.3390\/membranes11030225"},{"key":"ref_7","unstructured":"(2021, June 06). Extracorporeal Life Support Organization. Available online: https:\/\/www.elso.org\/Resources\/Guidelines.aspx."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1097\/CCM.0000000000002189","article-title":"Intensive Care Over Nations Investigators. Higher Fluid Balance Increases the Risk of Death From Sepsis: Results From a Large International Audit","volume":"45","author":"Sakr","year":"2017","journal-title":"Crit. Care Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1862","DOI":"10.1097\/CCM.0000000000004617","article-title":"Fluid Overload and Mortality in Adult Critical Care Patients-A Systematic Review and Meta-Analysis of Observational Studies","volume":"48","author":"Messmer","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1891","DOI":"10.1097\/CCM.0000000000001835","article-title":"Acute Kidney Injury in Critical Illness Study Group. Cumulative Fluid Balance and Mortality in Septic Patients with or Without Acute Kidney Injury and Chronic Kidney Disease","volume":"44","author":"Neyra","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1097\/CCM.0000000000003276","article-title":"Role of Active Deresuscitation After Resuscitation (RADAR) Investigators. Deresuscitation of Patients With Iatrogenic Fluid Overload Is Associated With Reduced Mortality in Critical Illness","volume":"46","author":"Silversides","year":"2018","journal-title":"Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1186\/s13054-019-2673-5","article-title":"Cumulative fluid accumulation is associated with the development of acute kidney injury and non-recovery of renal function: A retrospective analysis","volume":"23","author":"Zhang","year":"2019","journal-title":"Crit. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2252","DOI":"10.1007\/s00134-020-06310-0","article-title":"Fluid administration and monitoring in ARDS: Which management?","volume":"46","author":"Vignon","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann, H.P., Wheeler, A.P., Bernard, G.R., Thompson, B.T., Hayden, D., deBoisblanc, B., Connors, A.F., Hite, R.D., and Harabin, A.L. (2006). Comparison of two fluid-management strategies in acute lung injury. N. Engl. J. Med., 354, 2564\u20132575.","DOI":"10.1056\/NEJMoa062200"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s00134-016-4573-3","article-title":"Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: A systematic review and meta-analysis","volume":"43","author":"Silversides","year":"2017","journal-title":"Intensive Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.1007\/s00134-014-3360-2","article-title":"Impact of fluid balance on outcome of adult patients treated with extracorporeal membrane oxygenation","volume":"40","author":"Schmidt","year":"2014","journal-title":"Intensive Care Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1186\/s13054-018-2211-x","article-title":"Permissive fluid volume in adult patients undergoing extracorporeal membrane oxygenation treatment","volume":"22","author":"Kim","year":"2018","journal-title":"Crit. Care"},{"key":"ref_18","first-page":"2526","article-title":"Acute respiratory distress syndrome: The Berlin Definition","volume":"307","author":"Ranieri","year":"2012","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s13054-020-03428-x","article-title":"Mechanical power during extracorporeal membrane oxygenation and hospital mortality in patients with acute respiratory distress syndrome","volume":"25","author":"Chiu","year":"2021","journal-title":"Crit. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1186\/cc11454","article-title":"KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: A KDIGO summary (Part 1)","volume":"17","author":"Kellum","year":"2013","journal-title":"Crit. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1186\/s13054-016-1570-4","article-title":"The inflammatory response to extracorporeal membrane oxygenation (ECMO): A review of the pathophysiology","volume":"20","author":"Millar","year":"2016","journal-title":"Crit. Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1056\/NEJMra1608077","article-title":"Acute Respiratory Distress Syndrome","volume":"377","author":"Thompson","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s13613-018-0402-x","article-title":"Principles of fluid management and stewardship in septic shock: It is time to consider the four D\u2019s and the four phases of fluid therapy","volume":"8","author":"Malbrain","year":"2018","journal-title":"Ann. Intensive Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1898","DOI":"10.1097\/CCM.0000000000001141","article-title":"Impact of Acute Kidney Injury on Outcome in Patients With Severe Acute Respiratory Failure Receiving Extracorporeal Membrane Oxygenation","volume":"43","author":"Haneya","year":"2015","journal-title":"Crit. Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1097\/MCC.0000000000000559","article-title":"Continuous renal replacement therapy during extracorporeal membrane oxygenation: Why, when and how?","volume":"24","author":"Ostermann","year":"2018","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1164\/rccm.201806-1094OC","article-title":"Mechanical Ventilation Management during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome. An International Multicenter Prospective Cohort","volume":"200","author":"Schmidt","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1186\/s13054-015-1163-7","article-title":"Fluid overload and acute kidney injury: Cause or consequence?","volume":"19","author":"Ostermann","year":"2015","journal-title":"Crit. Care"}],"container-title":["Membranes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0375\/11\/8\/567\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:36:16Z","timestamp":1760164576000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0375\/11\/8\/567"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,28]]},"references-count":27,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["membranes11080567"],"URL":"https:\/\/doi.org\/10.3390\/membranes11080567","relation":{},"ISSN":["2077-0375"],"issn-type":[{"value":"2077-0375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,28]]}}}