ARDS: FACTT (Fluids and Catheters Treatment Trial)

Question 1

FACTT Clinical Q

Answer 1

In patients with ALI/ARDS that are intubated and receiving positive pressure ventilation, how does the conservative compare to the liberal fluid management strategy in reducing mortality?

Question 2

FACTT Bottom Line

Answer 2

Among patients with ALI/ARDS, a conservative fluid management strategy targeting a CVP <4 mmHg improves lung function, decreases ventilator days, and reduces ICU days compared to a liberal strategy.

Question 3

FACTT primary outcome

Answer 3

All cause mortality at 60 days

Dialysis at 60 days

Question 4

FACTT inclusion criteria

Answer 4

• Intubated patients receiving positive-pressure ventilation
• All patients had ALI (defined as PaO2:FiO2 ratio <300, bilateral infiltrates on CXR, and no evidence of LA hypertension)
• CVC or plan to insert CVC

Question 5

FACTT interventions

Answer 5

-All patients were on ARDS Network -(ARDSNet) protocol (low Vt).
Randomized to conservative vs. liberal fluid management strategy, and randomized to CVC or PAC
—Suspension of diuretic administration if in shock
-Received assigned catheter within four hours of randomization. PAC could be replaced with CVC if hemodynamically stable.

Question 6

FACTT Criticism

Answer 6

The conservative group was treated with a diuretic regimen that resulted in a net-even (rather than net-negative) fluid status