Comparison of Two Fluid-Management Strategies in Acute Lung Injury (FACTT)

The optimal fluid management strategy in ARDS was debated. Liberal fluids maintain perfusion but worsen pulmonary edema; conservative fluids may reduce edema but risk organ hypoperfusion.

Multicenter RCT (n=1,000) comparing conservative vs. liberal fluid management strategy in ALI/ARDS over 7 days.

Conservative fluid strategy improved oxygenation index, lung injury score, and increased ventilator-free days (14.6 vs 12.1 days, p<0.001) and ICU-free days. No difference in 60-day mortality or renal failure.

A conservative fluid strategy (targeting CVP <4 or PAOP <8) improves lung function and reduces time on ventilator in ARDS without harming kidneys. Avoid fluid overload in ARDS after initial resuscitation.

No mortality benefit. Excluded patients in shock. CVP/PAOP targets are now considered unreliable hemodynamic markers.