Table 4

Conservative compared to liberal fluid management for ARDS

Patient or population: adults with ARDS
Settings: intensive care
Intervention: conservative fluid strategy
Comparison: liberal fluid strategy
OutcomesIllustrative comparative risks (95% CI)Relative effect (95% CI)No. of participants (studies)Quality of evidence (GRADE)Comments
Control riskIntervention risk
Liberal fluid strategyConservative fluid strategy
Mortality (pooled up to 60 days)311 per 1000283 per 1000
(239 to 332)
RR 0.91
(0.77 to 1.07)
(five RCTs)
Due to serious indirectness and serious imprecision
Variable fluid strategies, fluid balance achieved and outcome reporting
Adverse event: AKI1000
(one study)
Due to serious imprecision
Single study. There were a similar number of renal failure free days between conservative and liberal fluid management groups. In a posthoc analysis where creatinine was adjusted for fluid balance, conservative fluid management was associated with lower incidence of AKI (58% vs 66%).
Adverse event: RRT141 per 1000100 per 1000
(70 to 139)
RR 0.71
(0.50 to 0.99)
(one study)
Due to serious imprecision
Single study
  • AKI, acute kidney injury; ARDS, acute respiratory distress syndrome; RRT, renal replacement therapy.