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Critical Care Medicine

Answer 3
  1. Fluid therapy to maintain a CVP of less than 4 mm Hg and a PAOP of less than 8 mm Hg. A recently published randomized study compared 7 days of conservative versus liberal fluid management strategies in 1000 patients with acute lung injury.4 The primary endpoint was death at 60 days. Secondary endpoints included the number of ventilator- free days and organ-failure-free days. Although 60-day mortality was not significantly different, ventilator-free days and time in the intensive care unit were reduced in the first 28 days using the conservative strategy. Acute lung injury is characterized by increased vascular permeability. Although early goal-directed therapy with appropriate fluid resuscitation is crucial, once acute lung injury has occurred, a more conservative approach to fluid therapy may be better than a more liberal approach.

    4. Wiedemann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid-management strategies in acute lung injury. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. N Engl J Med 2006;354:2564-75.

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