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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 (p0.001). 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, p0.001 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.

To compare the differences in characteristics and outcomes of cancer center patients with other subspecialty medical patients reviewed by rapid response teams.A retrospective cohort study of hospitalized general medicine patients, subspecialty medicine patients, and oncology patients requiring rapid response team activation over a 2-year period from September 2009 to August 2011.Five hundred fifty-seven subspecialty medical patients required rapid response team intervention.A single academic medical center in the southeastern United States (800+ bed) with a dedicated 50-bed inpatient comprehensive cancer care center.Data abstraction from computerized medical records and a hospital quality improvement rapid response database.Of the 557 patients, 135 were cancer center patients. Cancer center patients had a significantly higher Charlson Comorbidity Score (4.4 vs 2.9,0.001). Cancer center patients had a significantly longer hospitalization period prior to rapid response team activation (11.4 vs 6.1 d, p0.001). There was no significant difference between proportions of patients requiring ICU transfer between the two groups (odds ratio, 1.2; 95% CI, 0.8-1.8). Cancer center patients had a significantly higher in-hospital mortality compared with the other subspecialty medical patients (33% vs 18%; odds ratio, 2.2; 95% CI, 1.50-3.5). If the rapid response team event required an ICU transfer, this finding was more pronounced (56% vs 23%; odds ratio, 4.0; 95% CI, 2.0-7.8). The utilization of rapid response team resources during the 2-year period studied was also much higher for the oncology patients with 37.34 activations per 1,000 patient discharges compared with 20.86 per 1,000 patient discharges for the general medical patients.Oncology patients requiring rapid response team activation have a significantly higher in-hospital mortality rate, particularly if the rapid response team requires ICU transfer. Oncology patients also utilize rapid response team resources at a much higher rate.

o minimize patient discomfortin the intensive care unit (ICU),sedation and analgesia have be-come an integral part of criticalcare practice. Sedation and analgesia re-ducethestressresponse,provideanxiolysis,improve tolerance of ventilator support,and facilitate nursing care. Unfortunately,sedatives and analgesics have adverse ef-fects including respiratory depression anddelirium that can prolong mechanical ven-tilation. This problem can worsen patientoutcome and substantially increase healthcare costs (1, 2). Deliberate approaches tothe administration of sedatives includingdefined nurse-directed protocols (3, 4) anddaily interruption of continuous infusionsof sedatives (5) can lead to significant de-creases in duration of mechanical ventila-tion. Important complexity remains, how-ever, regarding the choice of appropriatesedative medications and methods of ad-ministration (6). A number of effective sed-ative agents are available, but they differconsiderably with regard to adverse effectsand costs.Clinical practice guidelines (7) assem-bled by the American College of CriticalCare Medicine of the Society of CriticalCare Medicine (SCCM) recommend the useof lorazepam given as intermittent intrave-nous bolus or continuous intravenous in-fusion for most patients. This recommen-dation is based in part on lower drugacquisition costs for lorazepam comparedwith other benzodiazepines such as midazo-lam, with equal or better levels of sedation inpatients requiring long-term sedation (8, 9).Many physicians and pharmacists prefer in-termittent bolus dosing of lorazepam ratherthan continuous infusions because of highlevels of drug accumulation and oversedationassociated with continuous infusions (10),and because of concerns regarding precipita-tion of drug in intravenous tubing (9, 11).