article168

FACTT

"Fluid Management Strategies in Acute Lung Injury".

Clinical Question:

Does a conservative fluid management strategy improve survival and other outcomes in patients with acute lung injury compared to a liberal fluid management strategy?

Bottom Line:

A conservative fluid management strategy did not significantly reduce 60-day mortality but improved lung function and shortened the duration of mechanical ventilation and intensive care without increasing nonpulmonary-organ failures compared to a liberal fluid management strategy.

Major Points:

Guidelines:

Current evidence does not support a definitive guideline for liberal or conservative fluid management in patients with established acute lung injury.

Design:

Multicenter, randomized, controlled trial with explicit protocols for conservative or liberal fluid management applied for seven days in 1,000 patients with acute lung injury

Population:

1,000 patients with acute lung injury, intubated, and receiving positive-pressure ventilation.

Interventions:

Participants were randomized to receive a conservative or liberal strategy of fluid management.

Outcomes:

Primary Outcome: Death from any cause at 60 days.
Secondary Outcomes: Number of ventilator-free days, organ-failure–free days, and measures of lung physiology.

Criticisms:

The study focused on a 7-day intervention and may not have captured long-term sequelae of fluid management strategies.

Funding:

Supported by contracts with the National Heart, Lung, and Blood Institute, National Institutes of Health. No potential conflict of interest relevant to this article was reported.