Table 1. Simplified Conservative Fluid Management Protocol (Fluid and Catheter Treatment Trial Lite).

Central Venous Pressure (Recommended)	Pulmonary Artery Occlusion Pressure (Optional)	Mean Arterial Pressure ≥ 60 mm Hg and Off Vasopressors ≥ 12 Hr
		Urine Output < 0.5 mL/kg/hr	Urine Output ≥ 0.5 mL/kg/hr
> 8	> 12	Furosemidea; reassess in 1 hr	Furosemidea; reassess in 4 hr
4–8	8–12	Give fluid bolus; reassess in 1 hr	Furosemidea; reassess in 4 hr
< 4	< 8	Give fluid bolus; reassess in 1 hr	No intervention; reassess in 4 hr

^arecommended furosemide dosing = begin with 20 mg bolus or 3 mg/hr infusion or last known effective dose. Double each subsequent dose until goal achieved (oliguria reversal or intravascular pressure target) or maximum infusion rate of 24 mg/hr or 160 mg bolus reached. Do not exceed 620mg/d. Also, if patient has heart failure, consider treatment with dobutamine.

This protocol was initiated within 4hr of randomization in enrolled patients and continued until unassisted breathing or study day 7, whichever occurred first.

Protocol meta-rules:

1. Discontinue maintenance fluids.
2. Continue medications and nutrition
3. Manage electrolytes and blood products per usual practice.
4. For shock, use any combination of fluid boluses (recommended fluid bolus = 15 mL/kg crystalloid [round to nearest 250 mL] or 1 unit packed red cells or 25 g albumin) and vasopressor(s) to achieve mean arterial pressure ≥ 60 mm Hg as fast as possible. Wean vasopressors as quickly as tolerated beginning 4 hr after blood pressure has stabilized.
5. Withhold diuretic therapy in renal failure (defined as dialysis dependence, oliguria with serum creatinine > 3mg/dL, or oliguria with serum creatinine 0–3 with urinary indices indicative of acute renal failure) and until 12 hr after last fluid bolus or vasopressor given.