Fluid therapy in common respiratory disorders such as acute respiratory distress syndrome, bronchial asthma, and patients receiving mechanical ventilation is discussed.

In patients with bronchial asthma, important aspects of fluid therapy, electrolyte disorders, and acid-base disorders are discussed.

Adequate hydration protects the lung epithelium and helps in promoting effective mucociliary clearance [1, 2]. In dehydration, cough is significantly more prevalent, even in healthy individuals [3]. Poor oral intake during illness, increased work of breathing due to airway obstruction, increased insensible fluid losses due to hyperventilation, cold sweat during an asthma attack, and fluid loss due to associated fever all contribute to the loss of body water and sodium chloride during an asthma attack [4].

Proper hydration is essential because dehydration worsens respiratory symptoms and lung function in patients with bronchial asthma [5].

Dehydration carries problems such as:

REFERENCES

1. Kalhoff H. Mild dehydration: a risk factor of broncho-pulmonary disorders? Eur J Clin Nutr. 2003;57(2):S81–7.
2. Åstrand AB, Hemmerling M, Root J, et al. Linking increased airway hydration, ciliary beating, and mucociliary clearance through ENaC inhibition. Am J Physiol Lung Cell Mol Physiol. 2015;308(1):L22–32.
3. Zanasi A, Mazzolini M, Fontana GA, et al. Alterations in the Hydration Status Affect Coughing in Otherwise Normal School Children. World Wide J. Multidiscip. Res. Dev. 2021;7(3):78–82.
4. Nievas IF, Anand KJ. Severe acute asthma exacerbation in children: a stepwise approach for escalating therapy in a pediatric intensive care unit. J Pediatr Pharmacol Ther. 2013;18(2):88–104.
5. Stookey JD, Brass B, Holliday A, et al. What is the cell hydration status of healthy children in the USA? Preliminary data on urine osmolality and water intake. Public Health Nutr. 2012;15(11):2148–56.
6. Moloney ED, Griffin S, Burke CM, et al. Release of inflammatory mediators from eosinophils following a hyperosmolar stimulus. Respir Med. 2003;97(8):928–32.
7. Yamauchi K, Ogasawara M. The Role of Histamine in the Pathophysiology of Asthma and the Clinical Efficacy of Antihistamines in Asthma Therapy. Int J Mol Sci. 2019;20(7):1733.
8. Sheldon JM. Intravenous use of fluids in bronchial asthma. JAMA. 1949;139(8):506–507
9. Kantor DB, Hirshberg EL, McDonald MC, et al. Fluid Balance Is Associated with Clinical Outcomes and Extravascular Lung Water in Children with Acute Asthma Exacerbation. Am J Respir Crit Care Med. 2018;197(9):1128–1135.
10. Alamoudi OS. Electrolyte disturbances in patients with chronic, stable asthma: effect of therapy. Chest. 2001;120(2):431–6.
11. Mohammad HA, Abdulfttah MT, Abdulazez AO, et al. A study of electrolyte disturbances in patients with chronic stable asthma and with asthma attacks. Egypt J Chest Dis Tuberc. 2014;63:529–34.
12. Das A, Patil S, Nair G, et al. Electrolyte disturbances in patients with acute exacerbation of bronchial asthma. JMSCR. 2018;6(9):315–319.
13. Hung CH, Chu DM, Wang CL, et al. Hypokalemia and salbutamol therapy in asthma. Pediatr Pulmonol. 1999;27(1):27–31.
14. Tsai WS, Wu CP, Hsu YJ, et al. Life-threatening hypokalemia in an asthmatic patient treated with high-dose hydrocortisone. Am J Med Sci. 2004;327(3):152–5.
15. Jain N, Kumari K, Roy S, et al. Hypocalcaemia-induced acute exacerbation of bronchial asthma: An unusual cause of a common disorder. Indian J Anaesth. 2020;64(9):820–821.
16. Kumari A, Nangrani K, Dolkar T, et al. Hypocalcemia Induced Bronchospasm. Cureus. 2022;14(6):e26339.
17. Kılıc H, Kanbay A, Karalezlı A, et al. The Relationship between Hypomagnesemia and Pulmonary Function Tests in Patients with Chronic Asthma. Med Princ Pract. 2018;27(2):139–144.
18. Vittal BG, Rudresha BM, Aliya N, et al. A study of serum electrolyte levels during nebulised salbutamol therapy. J. Clin. Diagn. Res. 2010;4(6):3460–3464
19. Kew KM, Kirtchuk L, Michell CI. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database of Systematic Reviews 2014;28(5):CD010909.
20. Griffiths B, Kew KM, Normansell R. Intravenous magnesium sulfate for treating children with acute asthma in the emergency department. Paediatr Respir Rev. 2016;20:45–47.
21. Su Z, Li R, Gai Z. Intravenous and nebulized magnesium sulfate for treating acute asthma in children: a systematic review and meta-analysis. PediatrEmerg Care. 2018;34(6):390–395.
22. Vasileiadis I, Alevrakis E, Ampelioti S, et al. Acid-Base Disturbances in Patients with Asthma: A Literature Review and Comments on Their Pathophysiology. J Clin Med. 2019;8(4):563.
23. Dias E, Shetty VP. A Study on Initial Arterial Blood Gas in Acute Asthmatic Children in Karnataka India. Acta Scientific Paediatrics 2023;6(1):14–16.
24. McFadden ER Jr. Acute severe asthma. Am J Respir Crit Care Med. 2003;168(7):740–59
25. McFadden ER, Lyons HA. Arterial blood gas tension in asthma. NEJM 1968;278(19):1027–1032.
26. Bagrecha M, Yannawar A, Gaikwad N, et al. A Prospective Study of Arterial Blood Gases in Bronchial Asthma in a Tertiary Care Hospital. MSCR 2019;7(12):82–86.
27. Shigemura M, Homma T, Sznajder JI. Hypercapnia: An Aggravating Factor in Asthma. J Clin Med. 2020;9(10):3207.
28. Rashid AO, Azam HM, DeBari VA, et al. Non-anion gap acidosis in asthma: clinical and laboratory features and outcomes for hospitalized patients. Ann Clin Lab Sci. 2008;38(3):228–34.
29. Mountain RD, Heffner JE, Brackett NC Jr, et al. Acid-base disturbances in acute asthma. Chest. 1990;98(3):651–5.
30. Liedtke AG, Lava SAG, Milani GP, et al. Selective ß2-adrenoceptor agonists and relevant hyperlactatemia: systematic review and meta-analysis. J Clin Med 2019;9(1):71.
31. Phoophiboon V, Singhagowinta P, Boonkaya S, et al. Salbutamol-induced lactic acidosis in status asthmaticus survivor. BMC Pulm Med. 2021;21(1):23.
32. Ruman-Colombier M, Rochat Guignard I, Di Paolo ER, et al. Prevalence and risk factors of lactic acidosis in children with acute moderate and severe asthma, a prospective observational study. Eur J Pediatr. 2021;180(4):1125–1131.
33. Kho SS, Nyanti LE, Muhammad NA, et al. The more you give, the worse it gets. Breathe 2021;17(3):210083
34. Bouachour G, Tirot P, Varache N, et al. Metabolic acidosis in severe acute asthma. Effect of alkaline therapy [French]. Rev Pneumol Clin. 1992;48(3):115–9.
35. Garber BG, Hébert PC, Yelle JD, et al. Adult respiratory distress syndrome: a systemic overview of incidence and risk factors. Crit Care Med. 1996;24(4):687–695.
36. Villar J, Blanco J, Kacmarek RM. Current incidence and outcome of the acute respiratory distress syndrome. Curr Opin Crit Care 2016;22(1):1–6.
37. Ma´ca J, Jor O, Holub M, et al. Past and present ARDS mortality rates: a systematic review. Respir Care 2017;62(1):113–22.
38. Wang Y, Zhang L, Xi X, et al. The Association Between Etiologies and Mortality in Acute Respiratory Distress Syndrome: A Multicenter Observational Cohort Study. Front Med (Lausanne). 2021;8:739596.
39. Vignon P, Evrard B, Asfar P, et al. Fluid administration and monitoring in ARDS: which management? Intensive Care Med. 2020;46(12):2252–2264.
40. Silversides JA, Fitzgerald E, Manickavasagam US, et al. Deresuscitation of Patients With Iatrogenic Fluid Overload Is Associated With Reduced Mortality in Critical Illness. Crit Care Med 2018;46(10):1600–1607.
41. Van Mourik N, Metske HA, Hofstra JJ, et al. Cumulative fluid balance predicts mortality and increases time on mechanical ventilation in ARDS patients. An observational cohort study. PLoS ONE 2019;14(10):e0224563.
42. Ho KS, Kohli P, Herrera Y, et al. Go Easy with the Fluids? Increased Mortality in Acute Respiratory Distress Syndrome with Hypervolemia. European Respiratory Journal 2020;56:3442.
43. Hu W, Zhang S, He Z, et al. Impact of Time-Varying Intensity of Mechanical Ventilation on 28-Day Mortality Depends on Fluid Balance in Patients With Acute Respiratory Distress Syndrome: A Retrospective Cohort Study. Front Med (Lausanne). 2022;9:906903.
44. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564–2575.
45. Grissom CK, Hirshberg EL, Dickerson JB, et al. Fluid management with a simplified conservative protocol for the acute respiratory distress syndrome*. Crit Care Med. 2015;43(2):288–95.
46. Silversides JA, Major E, Ferguson AJ, et al. 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. Intensive Care Med. 2017;43(2):155–70.
47. Griffiths MJD, McAuley DF, Perkins GD, et al. Guidelines on the management of acute respiratory distress syndrome. BMJ Open Respir Res. 2019;6(1):e000420.
48. Murphy CV, Schramm GE, Doherty JA, et al. The importance of fluid management in acute lung injury secondary to septic shock. Chest 2009;136(1):102–109.
49. Shi R, Hamzaoui O, De Vita N, et al. Vasopressors in septic shock: which, when, and how much? Ann Transl Med. 2020;8(12):794.
50. Munshi L, Rubenfeld G, Wunsch H. Adjuvants to mechanical ventilation for acute respiratory distress syndrome. Intensive Care Med. 2016;42(5):775–8.
51. Casey JD, Semler MW, Rice TW. Fluid Management in Acute Respiratory Distress Syndrome. Semin Respir Crit Care Med. 2019;40(1):57–65.
52. Cinotti R, Lascarrou JB, Azais MA, et al. Diuretics decrease fluid balance in patients on invasive mechanical ventilation: the randomized-controlled single blind, IRIHS study. Crit Care. 2021;25(1):98.
53. Seitz KP, Caldwell ES, Hough CL. Fluid management in ARDS: an evaluation of current practice and the association between early diuretic use and hospital mortality. J Intensive Care. 2020;8:78.
54. Zhang R, Chen H, Gao Z, et al. The Effect of Loop Diuretics on 28-Day Mortality in Patients with Acute Respiratory Distress Syndrome. Front. Med. 2021;8:740675.
55. Semler MW, Self WH, Wanderer JP, et al. SMART investigators and the Pragmatic Critical Care Research Group: Balanced crystalloids versus saline in critically ill adults. N Engl J Med 2018;378(9):829–839.
56. Brown RM, Wang L, Coston TD, et al. Balanced crystalloids versus saline in sepsis. A secondary analysis of the SMART clinical trial. Am J Respir Crit Care Med. 2019;200(12):1487–1495.
57. Hammond NE, Zampieri FG, Di Tanna GL, et al. Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis. NEJM Evid 2022;1(2).
58. Beran A, Altorok N, Srour O, et al. Balanced Crystalloids versus Normal Saline in Adults with Sepsis: A Comprehensive Systematic Review and Meta-Analysis. J Clin Med. 2022;11(7):1971.
59. Keddissi JI, Youness HA, Jones KR, et al. Fluid management in Acute Respiratory Distress Syndrome: A narrative review. Can J Respir Ther. 2019;55:1–8.
60. Myburgh JA, Finfer S, Bellomo R, et al. Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care. N Engl J Med 2012;367(20):1901–11.
61. Zarychanski R, Abou-Setta AM, Turgeon AF, et al. Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: A systematic review and meta-analysis. JAMA 2013;309(7):678–88.
62. Martin GS, Mangialardi RJ, Wheeler AP, et al. Albumin and furosemide therapy in hypoproteinemic patients with acute lung injury. Crit Care Med. 2002;30(10):2175–2182.
63. Martin GS, Moss M, Wheeler AP, et al. A randomized, controlled trial of furosemide with or without albumin in hypoproteinemic patients with acute lung injury. Crit Care Med. 2005;33(8):1681–1687.
64. Itagaki Y, Yoshida N, Banno M, et al. Efficacy of albumin with diuretics in mechanically ventilated patients with hypoalbuminemia: A systematic review and meta-analysis. Medicine (Baltimore). 2022;101(37):e30276.
65. Langer T, D’Oria V, Spolidoro GCI, et al. Fluid therapy in mechanically ventilated critically ill children: the sodium, chloride and water burden of fluid creep. BMC Pediatr. 2020;20(1):424.
66. Upadya A, Tilluckdharry L, Muralidharan V, et al.. Fluid balance and weaning outcomes. Intensive Care Med 2005;31(12):1643–7.
67. Flori HR, Church G, Liu KD, et al. Positive fluid balance is associated with higher mortality and prolonged mechanical ventilation in pediatric patients with acute lung injury. Crit Care Res Pract. 2011;2011:854142.
68. Ingelse SA, Wiegers HM, Calis JC, et al. Early Fluid Overload Prolongs Mechanical Ventilation in Children With Viral-Lower Respiratory Tract Disease. Pediatr Crit Care Med. 2017;18(3):e106–e111.
69. Samaddar S, Sankar J, Kabra SK, et al. Association of Fluid Overload with Mortality in Critically-ill Mechanically Ventilated Children. Indian Pediatr. 2018;55(11):957–961.
70. Wang W, Zhu S, He Q, et al. Fluid Balance and Ventilator-Associated Events Among Patients Admitted to ICUs in China: A Nested Case-Control Study. Crit Care Med. 2022;50(2):307–316.
71. Arrahmani I, Ingelse SA, van Woensel JBM, et al. Current Practice of Fluid Maintenance and Replacement Therapy in Mechanically Ventilated Critically Ill Children: A European Survey. Front Pediatr. 2022;10:828637.
72. Wrzosek A, Drygalski T, Garlicki J, et al. The volume of infusion fluids correlates with treatment outcomes in critically ill trauma patients. Front. Med. 2023;9:1040098.
73. Wiedemann HP. A perspective on the fluids and catheters treatment trial (FACTT). Fluid restriction is superior in acute lung injury and ARDS. Cleve Clin J Med. 2008;75(1):42–8.
74. Klompas M. Ventilator-Associated Events: What They Are and What They Are Not. Respir Care. 2019;64(8):953–961.
75. Li T, Zhou D, Zhao D, et al. Association between fluid intake and extubation failure in intensive care unit patients with negative fluid balance: a retrospective observational study. BMC Anesthesiol. 2022;22(1):170.
76. Ogbu OC, Murphy DJ, Martin GS. How to avoid fluid overload. Curr Opin Crit Care. 2015;21(4):315–21.
77. Van Regenmortel N, Verbrugghe W, Roelant E, et al. Maintenance fluid therapy and fluid creep impose more significant fluid, sodium, and chloride burdens than resuscitation fluids in critically ill patients: a retrospective study in a tertiary mixed ICU population. Intensive Care Med. 2018;44(4):409–17.
78. Bissell BD, Laine ME, Thompson et al. Impact of protocolized diuresis for de-resuscitation in the intensive care unit. Critical care. 2020;24(1):70.
79. Vora CS, Karnik ND, Gupta V, et al. Clinical Profile of Patients Requiring Prolonged Mechanical Ventilation and their Outcome in a Tertiary Care Medical ICU. J Assoc Physicians India. 2015;63(10):14–9.
80. Kamdar PK, Kakaiya RR. A study of electrolytes imbalance in mechanically ventilated Patients. International Journal of Scientific Research 2020;9(1):64–67.
81. Morganroth ML, Grum CM. Weaning from Mechanical Ventilator. J Intensive Care Med 1988;3:109–120.
82. Zhao Y, Li Z, Shi Y, et al. Effect of hypophosphatemia on the withdrawal of mechanical ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease. Biomed Rep. 2016;4(4):413–416.
83. Wang L, Xiao C, Chen L, et al. Impact of hypophosphatemia on outcome of patients in intensive care unit: a retrospective cohort study. BMC Anesthesiol. 2019;19(1):86.
84. Javdan Z, Talakoub R, Honarmand A, et al. The predicting ability of serum potassium to assess the duration of mechanical ventilation in critically ill patients. Adv Biomed Res. 2015;4:133.
85. Thongprayoon C, Cheungpasitporn W, Chewcharat A, et al. Serum ionised calcium and the risk of acute respiratory failure in hospitalised patients: a single-centre cohort study in the USA. BMJ Open. 2020;10(3):e034325.
86. Kumar S, Honmode A, Jain S, et al. Does magnesium matter in patients of Medical Intensive Care Unit: A study in rural Central India. Indian J Crit Care Med. 2015;19(7):379–83.
87. Bigatello LM, Patroniti N, Sangalli F. Permissive hypercapnia. Curr Opin Crit Care. 2001;7(1):34–40.
88. Morales-Quinteros L, Camprubí-Rimblas M, Bringué J, et al. The role of hypercapnia in acute respiratory failure. Intensive Care Med Exp. 2019;7(1):39.
89. Banga A, Khilnani GC. Post-hypercapnic alkalosis is associated with ventilator dependence and increased ICU stay. COPD. 2009;6(6):437–40.