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Fluid management with a simplified conservative protocol for the acute respiratory distress syndrome*.
Crit Care Med. 2015 Feb; 43(2):288-95.CC

Abstract

OBJECTIVES

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.

DESIGN

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.

SETTING

ICUs of Acute Respiratory Distress Syndrome Network participating hospitals.

PATIENTS

Five hundred three subjects managed with FACTT Conservative, 497 subjects managed with FACTT Liberal, and 1,124 subjects managed with FACTT Lite.

INTERVENTIONS

Fluid management by protocol.

MEASUREMENTS AND MAIN 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+Show Affiliations

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.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25599463

Citation

Grissom, Colin K., et al. "Fluid Management With a Simplified Conservative Protocol for the Acute Respiratory Distress Syndrome*." Critical Care Medicine, vol. 43, no. 2, 2015, pp. 288-95.
Grissom CK, Hirshberg EL, Dickerson JB, et al. Fluid management with a simplified conservative protocol for the acute respiratory distress syndrome*. Crit Care Med. 2015;43(2):288-95.
Grissom, C. K., Hirshberg, E. L., Dickerson, J. B., Brown, S. M., Lanspa, M. J., Liu, K. D., Schoenfeld, D., Tidswell, M., Hite, R. D., Rock, P., Miller, R. R., & Morris, A. H. (2015). Fluid management with a simplified conservative protocol for the acute respiratory distress syndrome*. Critical Care Medicine, 43(2), 288-95. https://doi.org/10.1097/CCM.0000000000000715
Grissom CK, et al. Fluid Management With a Simplified Conservative Protocol for the Acute Respiratory Distress Syndrome*. Crit Care Med. 2015;43(2):288-95. PubMed PMID: 25599463.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fluid management with a simplified conservative protocol for the acute respiratory distress syndrome*. AU - Grissom,Colin K, AU - Hirshberg,Eliotte L, AU - Dickerson,Justin B, AU - Brown,Samuel M, AU - Lanspa,Michael J, AU - Liu,Kathleen D, AU - Schoenfeld,David, AU - Tidswell,Mark, AU - Hite,R Duncan, AU - Rock,Peter, AU - Miller,Russell R,3rd AU - Morris,Alan H, AU - ,, PY - 2015/1/20/entrez PY - 2015/1/20/pubmed PY - 2015/3/24/medline SP - 288 EP - 95 JF - Critical care medicine JO - Crit. Care Med. VL - 43 IS - 2 N2 - OBJECTIVES: 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. DESIGN: 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. SETTING: ICUs of Acute Respiratory Distress Syndrome Network participating hospitals. PATIENTS: Five hundred three subjects managed with FACTT Conservative, 497 subjects managed with FACTT Liberal, and 1,124 subjects managed with FACTT Lite. INTERVENTIONS: Fluid management by protocol. MEASUREMENTS AND MAIN 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. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/25599463/Fluid_management_with_a_simplified_conservative_protocol_for_the_acute_respiratory_distress_syndrome__ L2 - https://dx.doi.org/10.1097/CCM.0000000000000715 DB - PRIME DP - Unbound Medicine ER -