title: Fluid management with a simplified conservative protocol for the acute respiratory distress syndrome*.
abstract: OBJECTIVE
  In the Fluid and Catheter Treatment Trial (FACTT) of the National Institutes of Health Acute Respiratory Distress Syndrome Network, a conservative fluid protocol (FACTT Conservative) resulted in a lower cumulative fluid balance and better outcomes than a liberal fluid protocol (FACTT Liberal). Subsequent Acute Respiratory Distress Syndrome Network studies used a simplified conservative fluid protocol (FACTT Lite). The objective of this study was to compare the performance of FACTT Lite, FACTT Conservative, and FACTT Liberal protocols.
  
  
  METHODS
  Retrospective comparison of FACTT Lite, FACTT Conservative, and FACTT Liberal. Primary outcome was cumulative fluid balance over 7 days. Secondary outcomes were 60-day adjusted mortality and ventilator-free days through day 28. Safety outcomes were prevalence of acute kidney injury and new shock.
  
  
  METHODS
  ICUs of Acute Respiratory Distress Syndrome Network participating hospitals.
  
  
  METHODS
  Five hundred three subjects managed with FACTT Conservative, 497 subjects managed with FACTT Liberal, and 1,124 subjects managed with FACTT Lite.
  
  
  METHODS
  Fluid management by protocol.
  
  
  RESULTS
  Cumulative fluid balance was 1,918 ± 323 mL in FACTT Lite, -136 ± 491 mL in FACTT Conservative, and 6,992 ± 502 mL in FACTT Liberal (p < 0.001). Mortality was not different between groups (24% in FACTT Lite, 25% in FACTT Conservative and Liberal, p = 0.84). Ventilator-free days in FACTT Lite (14.9 ± 0.3) were equivalent to FACTT Conservative (14.6 ± 0.5) (p = 0.61) and greater than in FACTT Liberal (12.1 ± 0.5, p < 0.001 vs Lite). Acute kidney injury prevalence was 58% in FACTT Lite and 57% in FACTT Conservative (p = 0.72). Prevalence of new shock in FACTT Lite (9%) was lower than in FACTT Conservative (13%) (p = 0.007 vs Lite) and similar to FACTT Liberal (11%) (p = 0.18 vs Lite).
  
  
  CONCLUSIONS
  FACTT Lite had a greater cumulative fluid balance than FACTT Conservative but had equivalent clinical and safety outcomes. FACTT Lite is an alternative to FACTT Conservative for fluid management in Acute Respiratory Distress Syndrome.
authors.affiliation: 1Division of Critical Care Medicine, Intermountain Medical Center, Murray, UT. 2Division of Pulmonary and Critical Care, Department of Medicine, University of Utah, Salt Lake City, UT. 3Division of Pediatric Critical Care, University of Utah, Salt Lake City, UT. 4College of Pharmacy, University of Utah, Salt Lake City, UT. 5Division of Nephrology, University of California San Francisco, San Francisco, CA. 6Division of Critical Care Medicine, University of California San Francisco, San Francisco, CA. 7Biostatistics Center, Massachusetts General Hospital, Boston, MA. 8Division of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, MA. 9Respiratory Institute, Cleveland Clinic, Cleveland, OH. 10Department of Anesthesiology, University of Maryland, Baltimore, MD.
authors.forename: Colin K
authors.initials: CK
authors.lastname: Grissom
authors.forename: Eliotte L
authors.initials: EL
authors.lastname: Hirshberg
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dickerson
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Brown
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lanspa
authors.forename: Kathleen D
authors.initials: KD
authors.lastname: Liu
authors.forename: David
authors.initials: D
authors.lastname: Schoenfeld
authors.forename: Mark
authors.initials: M
authors.lastname: Tidswell
authors.forename: R Duncan
authors.initials: RD
authors.lastname: Hite
authors.forename: Peter
authors.initials: P
authors.lastname: Rock
authors.forename: Russell R
authors.initials: RR
authors.lastname: Miller
authors.forename: Alan H
authors.initials: AH
authors.lastname: Morris
mesh_terms: D002496:Central Venous Pressure; D002985:Clinical Protocols; D004232:Diuretics / Q000008:administration & dosage; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005665:Furosemide / Q000008:administration & dosage; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011897:Random Allocation; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012128:Respiratory Distress Syndrome / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012769:Shock / Q000453:epidemiology* / Q000401:mortality; D014481:United States / Q000453:epidemiology; D014882:Water-Electrolyte Balance
chemical_list: D004232:Diuretics; D005665:Furosemide