Table 2.

Simplified Algorithm for Conservative Management of Fluids in Patients With ALI, Based on Protocol Used in the FACTT^*

CVP, mm Hg (Recommended)	PAOP, mm Hg (Optional)	MAP ≥ 60 mm Hg and Not Receiving Vasopressors for ≥ 12 h
		Average Urine Output < 0.5 mL/kg/h	Average Urine Output ≥ 0.5 mL/kg/h
> 8	> 12	Furosemide†; reassess in 1 h	Furosemide; reassess in 4 h
4–8	8–12	Fluid bolus as fast as possible‡; reassess in 1 h	Furosemide; reassess in 4 h
< 4	< 8	Fluid bolus as fast as possible‡; reassess in 1 h	No intervention; reassess in 4 h

^*CVP = central venous pressure; PAOP = pulmonary artery occlusion pressure; MAP = mean arterial pressure. Reprinted with the courtesy of the NHLBI Acute Respiratory Distress Syndrome Network. Patients must have had a MAP of > 60 mm Hg without requiring vasopressors for at least 12 h before this protocol is initiated.

^†Furosemide dosing: begin with a 20-mg bolus, 3 mg/h infusion, or last known effective dose. Double each subsequent dose until the goal is achieved (oliguria reversal or intravascular pressure target), with a maximal dose of 160-mg bolus or 24 mg/h. Do not exceed 620 mg/d. If the patient has heart failure, treatment with dobutamine may be considered. Diuretic therapy should be withheld for patients with renal failure, which is defined as dialysis dependence, oliguria with a serum creatinine level of > 2 mg/dL, or oliguria with a serum creatinine level of < 2 mg/dL but with urinary indices indicative of acute renal failure.

^‡Fluid bolus: 15 mL/kg crystalloid (round to nearest 250 mL) or 1 unit of packed RBCs or 25 g of albumin.