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Background There is significant data in the medical and surgical literature supporting the correlations between positive volume balance and negative outcomes such as AKI, prolonged mechanical ventilation, intensive care unit and hospital length of stay and increased mortality. Methods This single-center, retrospective chart review included adult patients identified from a Trauma Registry database. The primary outcome was the total ICU LOS. Secondary outcomes include hospital LOS, ventilator-free days, incidence of compartment syndrome, acute respiratory distress syndrome (ARDS), renal replacement therapy (RRT), and days of vasopressor therapy. Results In general, baseline characteristics were similar between groups with the exception of mechanism of injury, FAST exam, and disposition from the ED. The ICU LOS was shortest in the negative fluid balance and longest in the positive fluid balance group (4 days vs 6 days, P = .001). Hospital LOS was also shorter in the negative balance group than that of the positive balance group (7 days vs 12 days, P < .001). More patients in the positive balance group experienced acute respiratory distress syndrome compared to the negative balance group (6.3% vs 0%, P = .004). There was no significant difference in the incidence of renal replacement therapy, days of vasopressor therapy, or ventilator-free days. Discussion A negative fluid balance at seventy-two hours was associated with a shorter ICU and hospital LOS in critically ill trauma patients. Our observed correlation between positive volume balance and total ICU days merits further exploration with prospective, comparative studies of lower volume resuscitation to key physiologic endpoints compared with routine standard of care.

Bronchopleural fistula (BPF) is a pathological communication between bronchial tree and pleural space. BPF has multiple etiologies but postsurgical ones carry the highest incidence and the worst prognosis. Diagnosis is based on the clinical presentation and confirmation with radiological imaging (chest X-ray, computed tomography scan) or bronchoscopy. Management of BPF involves a combination of surgical procedures, medical therapy and diagnostic and therapeutic bronchoscopy. Anesthetic considerations and management focus in perioperative optimization of intravascular volume status, proper and careful isolation of the affected lung to avoid spillage of contaminated material into the unaffected lung, and assurance of proper ventilation (either by conventional or special ventilatory techniques) during and after the operation.