Conservative Fluid Management Decreases Ventilator Days but not Mortality Compared with Liberal Fluid Management in ARDS

by Joseph Esherick, M.D., FAAFP, FHM

A retrospective study compared the performance of Fluid and Catheter Treatment Trial (FACTT) Lite, FACTT Conservative, and FACTT Liberal. The prior FACTT demonstrated that conservative fluids is superior to liberal fluids for ARDS. A simplified conservative fluid protocol (FACTT Lite) has now been shown to have equivalent results to the FACTT conservative fluid protocol.  Conservative fluid management decreases ventilator days (by two days) but resulted in no mortality benefit compared with liberal fluid management. FACTT Lite protocol led to no diuretics until MAP > 60 for at least twelve hours.

 

Central venous

pressure (CVP)

Pulmonary artery

occlusion pressure

UO<0.5 mL/kg/hr

UO>0.5 mL/kg/hr

>8 >12 Furosemide; reassess in 1 h

Furosemide; reassess in 4 h

4-8 8-12 Fluid bolus; reassess in 1 h Furosemide; reassess in 4 h
<4 <8 Fluid bolus; reassess in 1 h No intervention; reassess in 4 h

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