What is the preferred fluid management strategy in ARDS to minimize pulmonary edema while maintaining perfusion?

• A. Liberal fluid administration to maximize preload.
• B. Conservative (restrictive) fluid strategy.
• C. Routine high-volume diuresis for all patients.
• D. No fluids should be given to avoid edema.

Answer: (B)

In ARDS, how fluids are managed matters for both edema and perfusion. The goal is to prevent excess fluid from accumulating in the lungs, which worsens alveolar edema and gas exchange, while still keeping enough intravascular volume to maintain organ perfusion. A conservative (restrictive) fluid strategy after initial stabilization minimizes pulmonary edema and improves oxygenation without compromising blood flow. If a patient shows signs of hypoperfusion or shock, fluids are given judiciously and vasopressors or inotropes are used as needed, rather than defaulting to large-volume fluids for everyone. Routine high-volume diuresis for all isn’t appropriate because some patients may need fluid to sustain perfusion, and giving no fluids at all risks hypoperfusion. Liberal fluid administration would increase pulmonary edema and worsen outcomes, so the restrictive approach best balances the need to keep blood flow while limiting edema.