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.
: It is feasible for a single operator to perform PDT with continuous bronchoscopic guidance when using the EZT on cadaver and mannequin models. Clinical studies are warranted to evaluate this new tool.
A new model for the post-MICU transition of care, with the MICU team continuing to manage all patients transferred to the medical ward for at least 24 hours, significantly decreased duration of hospital stay after MICU transfer without affecting MICU readmission and mortality rate. The implementation of this model may lower medical costs and make transition of care safer without adverse outcomes.
The RSBI measurement is significantly decreased by the base flow delivered through modern ventilators in the flow trigger mode. If RSBI is measured through the ventilator in the flow trigger mode, the difference should be considered when using RSBI to assess readiness for weaning from mechanical ventilation.
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