Results from the largest controlled clinical trial of fluid management methods in patients with severe lung injury provide important new information on the risks and benefits of patient care strategies currently used in the intensive care unit. The two studies that comprised the trial showed that for patients with acute lung injury or its more severe form, acute respiratory distress syndrome, less fluid is better than more, and a shorter, less invasive catheter is as helpful as and safer than a longer catheter for monitoring patients. The trial was conducted by scientists from the Acute Respiratory Distress Syndrome Clinical Research Network of the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.

Investigators from the Fluid and Catheter Treatment Trial (FACTT) presented the findings May 21 at the American Thoracic Society (ATS) International Conference in San Diego. The results were also published early online concurrently by the New England Journal of Medicine (NEJM). The study comparing the use of the longer pulmonary artery catheter to the shorter central venous catheter for managing patients is published in the May 25 print issue of NEJM; the study evaluating fluid management strategies will appear in the June 15 print issue of NEJM.

Acute lung injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) are life-threatening lung conditions that affect more than 190,000 people in the United States each year, based on an estimate published in the October 20, 2005, NEJM. Thirty percent to 60 percent of cases result in death. ALI/ARDS develops in patients who are critically ill with other diseases such as pneumonia or sepsis (severe and widespread bacterial infection), or who have sustained major injuries. Fluid builds up in the lungs, and as a result, breathing is difficult, and other organs such as kidneys, liver, heart or brain fail if they do not get enough oxygen from the blood. There is no specific drug treatment for ALI/ARDS. Patients are placed in the intensive care unit (ICU) and supported with mechanical ventilators (breathing machines) and intravenous fluids such as saline (salt water), blood, or drugs such as dobutamine to improve heart function or diuretics to increase fluid output.
"A key focus of caring for these critically ill patients is management of fluids," said NHLBI Director Elizabeth G. Nabel, MD. "Fluid management in patients with ALI/ARDS has been the subject of intense debate for decades. We now have answers to two important questions to help guide critical care specialists on the best ways to support patients with severe lung injury."

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