Fluid management with a simplified conservative protocol for the acute respiratory distress syndrome*.
Fluid management with a simplified conservative protocol for the acute respiratory distress syndrome*.
复制标题
DOI：
10.1097/ccm.0000000000000715
复制
发表时间：
2015-02
影响因子：
8.8
通讯作者：
National Heart Lung and Blood Institute Acute Respiratory Distress Syndrome Clinical Trials Network
中科院分区：
文献类型：
--
作者：
Grissom CK;Hirshberg EL;Dickerson JB;Brown SM;Lanspa MJ;Liu KD;Schoenfeld D;Tidswell M;Hite RD;Rock P;Miller RR 3rd;Morris AH;National Heart Lung and Blood Institute Acute Respiratory Distress Syndrome Clinical Trials Network
在美国国立卫生研究院急性呼吸窘迫综合征网络的液体和导管治疗试验（FACTT）中，保守液体方案（FACTT Conservative）导致的累积液体平衡低于自由液体方案（FACTT Liberal），结局更好。随后的急性呼吸窘迫综合征网络研究使用简化的保守液体方案（FACTT Lite）。本研究的目的是比较FACTT Lite、FACTT Conservative和FACTT Liberal方案的性能。FACTT Lite、FACTT Conservative和FACTT Liberal的回顾性比较。主要结局为7天内累积液体平衡。次要结局为60天校正死亡率和至第28天的无呼吸机天数。安全性结局为急性肾损伤和新发休克的发生率。急性呼吸窘迫综合征网络参与医院的重症监护室。503例受试者接受FACTT保守治疗，497例受试者接受FACTT自由治疗，1，124例受试者接受FACTT精简型治疗。按方案进行液体管理。FACTT Lite的累积液体平衡为1，918 ± 323 mL，FACTT Conservative为−136 ±491 mL，FACTT Liberal为6，992 ± 502 mL（p < 0.001）。两组的死亡率无差异（FACTT Lite组为24%，FACTT保守组和Liberal组为25%，p = 0.84）。FACTT Lite中的无呼吸机天数（14.9 ±0.3）与FACTT Conservative（14.6±0.5）相当（p = 0.61），且大于FACTT Liberal（12.1 ±0.5，p < 0.001 vs Lite）。FACTT Lite组和FACTT保守组的急性肾损伤患病率分别为58%和57%（p = 0.72）。FACTT Lite组新发休克的发生率（9%）低于FACTT保守组（13%）（p = 0.007 vs Lite），与FACTT Liberal组（11%）相似（p = 0.18 vs Lite）。FACTT Lite的累积液体平衡大于FACTT Conservative，但具有等同的临床和安全性结局。FACTT Lite是FACTT Conservative的替代产品，用于急性呼吸窘迫综合征的液体管理。
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. 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. ICUs of Acute Respiratory Distress Syndrome Network participating hospitals. Five hundred three subjects managed with FACTT Conservative, 497 subjects managed with FACTT Liberal, and 1,124 subjects managed with FACTT Lite. Fluid management by protocol. 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). 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.