GNYHA’s First Critical Controversies Debate Addresses Fluid Management in COVID-19

December 7, 2020

The first virtual meeting of GNYHA’s Critical Care Controversies series highlighted the management of intravenous fluids and its potential effect on outcomes such as acute kidney injury and respiratory failure. The Critical Care Controversies Series of debate-style programs will feature intensive care unit clinicians advocating opposite sides of a provocative position statement, with audience members indicating their agreement or disagreement with the statement prior to and at the conclusion of each debate. The Controversies series is intended to build a community among clinicians.

The first event addressed the comparison of two fluid-management strategies in acute lung injury in COVID-19 patients. The moderator, Mark Nunnally, MD, Professor of Neurology, Surgery, and Medicine, and Director, Adult Critical Care Services at NYU Langone Health, began the debate by asking, “Did our extremely conservative strategy of fluids lead to us doing things for our patients that increased the incidence of renal failure?”

Panelist Gulrukh Zaidi, MD, Associate Professor of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine at Northwell Health, argued that a conservative fluid strategy was the right side of the argument. Among her conclusions: COVID-19 acute respiratory distress syndrome (ARDS) should be managed using evidence-based strategies and the objective assessment of volume status to allow for the tailoring of fluid management goals during critical illness. Panelist George Coritsidis, MD, Professor of Medicine & Surgery and Chief, Division of Nephrology at NYC Health + Hospitals/Elmhurst, posed a pro-fluid argument. In his discussion, he noted the hallmarks of ARDS; the balance between kidney perfusion (with liberal fluid) and ARDS resolution (with conservative fluid), and the relationships between ARDS, sepsis, and acute kidney injury. He noted that adequate volume status in the critically ill patient is vital, and that proper ARDS management must include assessment of the patient’s whole body. In the spirit of the debate format, the speakers may have been arguing a position with which they do not agree fully.

The second Controversies webinar, scheduled for January 7, will discuss whether COVID-19-associated ARDS requires special management compared to non-COVID-19 ARDS.