Fluid management and a bronchodilator use
Because vascular and epithelial permeability is increased
in ARDS, fluid management is one of the most difficult
measures to manage in septic shock patients with ARDS.
A conservative fluid management strategy maintaining arelatively low central venous pressure is associated with
the need for fewer days of mechanical ventilation compared
with a liberal fluid management strategy in ARDS
[42]. However, conservative fluid management is highly
recommended after hemodynamic stabilization in ARDS
patients. In hemodynamically unstable patients, dynamic
monitoring of lung fluid balance needs to be implemented
to guide the administration of fluids in ARDS
patients [43]. Despite a putative beneficial role in the
resolution of alveolar edema seen in preliminary studies,
recent evidence has indicated significant detrimental
effects associated with beta-2 agonist use in ARDS
patients [44].