The transudation of fluid across the alveolar capillary membrane is proportional to the mean pulmonary capillary pressure, as predicted by Starling's law. The reduction of hydrostatic forces in patients with ARDS reduces pulmonary edema formation and improves arterial oxygenation, but this must be balanced against the need to maintain cardiac output and adequate tissue perfusion. The circumspect use of diuretics and fluid restriction in patients with normal renal function does not appear to have long-term detrimental effects. In patients with coexisting renal failure, hemofiltration improves serum chemistry and produces the desired negative fluid balance.
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