Appendix I FACTT Algorithm: Composite Protocol …

1 algorithm Version 2, rev. 10/12/2000 NOTE: numbers in upper right hand corner of each cell = cell numbers; superscripts refer to footnotes that may modify Study Version IIARDSNet Study 05 Appendix I FACTT algorithm : Composite Protocol -Version 2 Intravascular PressureMAP 60 mm Hg AND off vasopressors(Dopamine 5 mcg/kg/min is not a vasopressor)CVPPAOPGA verage UOP < ml/kg/hrAverage UOP ml/kg/hrConservativeLiberalConservativeLiberalMAP< 60 mm Hgor on:dopamine >5mcg/kg/min orany dose causesof shock < & mottledwith capillary refill >2 ofineffectivecirculation < Cold & mottledwith capillary refill> 2 OR Absence ofineffective circulationcriteriaRange I> 13> 18> 18> 24 KVO ,2,4 KVO ,2,4 KVO ,3,4 KVO IV ,3,4 Range II9-1315-1813-1819-24 1 VasopressorFFluid bolusFKVO IV4 DobutamineAKVO ,2,4 KVO IV12 DobutamineAKVO IV ,3,4 Range IIIL iberal: 17 KVO IV4-810-148-1214-18 Fluid bolusC5 Fluid bolusC9 Fluid bolusC 13 Conservative: ,3,4 Range IVLiberal.

2 19 Fluid bolusD< 4< 10< 8< 14 2 Fluid bolusFVasopressorFFluid bolusC6 Fluid bolusC10 Fluid bolusC 14 Conservative:KVO IV 20 Cell numberSuperscript-refersto footnotesAlgorithm Version 2, rev. 10/12/2000 NOTE: numbers in upper right hand corner of each cell = cell numbers; superscripts refer to footnotes that may modify Study Version IIARDSNet Study 05 FACTT algorithm : CVC ConservativeMAP 60 mm Hg AND off vasopressors(Dopamine 5 mcg/kg/min is not a vasopressor)Average UOP < ml/kg/hrAverage UOP ml/kg/hrCentralVenousPressure(mmHg)MAP< 60 mm Hgor on: dopamine>5 mcg/kg/min orany dose ofanothervasopressorConsider correctablecauses of shock & mottledwith capillary refill >2 sec(all 3 criteria present)Effective CirculationAbsence of ineffectivecirculation criteriaIneffectiveCirculation Cold & mottled withcapillary refill > 2 sec(all 3 criteria present)

3 Effective Circulation Absence of ineffectivecirculation criteria> 13 KVO IV ,2,4 KVO IV ,2,4 KVO IV ,3,4 KVO IV ,3,49-13 1* VasopressorF==Fluid bolusFKVO IV 4 DobutamineAKVO IV ,2,4 KVO IV 12 DobutamineAKVO IV ,3,44-8 Fluid bolusC 5 Fluid bolusC 9 Fluid bolusC 13 ,3,4 < 4 2 Fluid bolusFVasopressorFFluid bolusC 6 Fluid bolusC 10 Fluid bolusC 14 20 KVO IVGOAL CELLA lgorithm Version 2, rev.

4 10/12/2000 NOTE: numbers in upper right hand corner of each cell = cell numbers; superscripts refer to footnotes that may modify Study Version IIARDSNet Study 05 FACTT algorithm : CVC LiberalMAP 60 mm Hg AND off vasopressors(Dopamine 5 mcg/kg/min is not a vasopressor)Average UOP < ml/kg/hrAverage UOP ml/kg/hrCentralVenousPressure(mmHg)MAP< 60 mm Hgor on: dopamine>5 mcg/kg/min orany dose ofanothervasopressorConsider correctablecauses of shock & mottledwith capillary refill >2 sec(all 3 criteria present)Effective CirculationAbsence of ineffectivecirculation criteriaIneffectiveCirculation Cold & mottledwith capillary refill2 sec(all 3 criteria present)Effective Circulation Absence of ineffectivecirculation criteria> 18 KVO IV ,2,4 KVO IV ,2,4 KVO IV ,3,4 KVO IV ,3,415-18 1 * VasopressorF==Fluid bolusFKVO IV 4 DobutamineAKVO IV ,2,4 KVO IV 12 DobutamineAKVO IV ,3.

5 410-14 Fluid bolusC 5 Fluid bolusC 9 Fluid bolusC 13 17 KVO IVGOAL CELL< 10 2 Fluid bolusFVasopressorFFluid bolusC 6 Fluid bolusC 10 Fluid bolusC 14 19 Fluid bolusDAlgorithm Version 2, rev. 10/12/2000 NOTE: numbers in upper right hand corner of each cell = cell numbers; superscripts refer to footnotes that may modify Study Version IIARDSNet Study 05 FACTT algorithm : PAC ConservativeMAP 60 mm Hg AND off vasopressors(Dopamine 5 mcg/kg/min is not a vasopressor)Average UOP < ml/kg/hrAverage hr UOP ml/kg/hrPulmonaryArteryOcclusionPressure (mm Hg)CVP(mm Hg)Use only ifPA occlusionpressureunobtainableMAP< 60 mm Hgor on.

6 Dopamine >5mcg/kg/min orany dose correctablecauses of shock < (or cold & mottledwith capillary refill >2 sec if CIunavailable) (or absence ofineffective circulationcriteria if CIunavailable) < (or Cold & mottledwith capillary refill > 2 sec if CIunavailable) (or absence ofineffective circulationcriteria if CIunavailable)>18>13 KVO IV ,2,4 KVO IV ,2,4 KVO IV ,3,4 KVO IV ,3,413-189-13 1*VasopressorF==Fluid bolusFKVO IV 4 DobutamineAKVO IV ,2,4 KVO IV 12 DobutamineAKVO IV ,3,48-124-8 Fluid bolusC 5 Fluid bolusC 9 Fluid bolusC 13 ,3,4 <8<4 2 Fluid bolusFVasopressorFFluid bolusC 6 Fluid bolusC 10 Fluid bolusC 14 20 KVO IVGOAL CELLA lgorithm Version 2, rev.

7 10/12/2000 NOTE: numbers in upper right hand corner of each cell = cell numbers; superscripts refer to footnotes that may modify Study Version IIARDSNet Study 05 FACTT algorithm : PAC LiberalMAP 60 mm Hg AND off vasopressors(Dopamine 5 mcg/kg/min is not a vasopressor)Average UOP < ml/kg/hrAverage UOP ml/kg/hrPulmonaryArteryOcclusionPressure(mm Hg)CVP(mm Hg)Use only ifPA occlusionpressureunobtainableMAP< 60 mm Hgor on: dopamine>5 mcg/kg/min orany dose correctablecauses of shock < (or cold & mottledwith capillary refill >2 sec if CIunavailable) (or absence ofineffective circulationcriteria if CIunavailable) < (or cold & mottled withcapillary refill > 2 secif CI unavailable) (or absence ofineffective circulationcriteria if CIunavailable)

8 >24>18 KVO IV ,2,4 KVO IV ,2,4 KVO IV ,3,4 KVO IV ,3,419-2415-18 1*VasopressorF==Fluid bolusFKVO IV 4 DobutamineAKVO IV ,2,4 KVO IV 12 DobutamineAKVO IV ,3,414-1810-14 Fluid bolusC 5 Fluid bolusC 9 Fluid bolusC 13 17 KVO IVGOAL CELL <14<10 2 Fluid bolusFVasopressorFFluid bolusC6 Fluid bolusC10 Fluid bolusC14 19 Fluid bolusD