Fluid management in acute kidney injury should be liberal when needed

Over the course of the last 15 years, there has been tremendous focus on the adverse consequences of fluid overload. In the setting of the acute respiratory distress syndrome, the landmark Fluids and Catheters Treatment Trial (FACTT) demonstrated that a fluid conservative strategy, targeting a central venous pressure <4 mm Hg or a pulmonary artery occlusion pressure <8 mm Hg, was associated with an increased number of ventilator-free days (a composite of survival and time on the ventilator in survivors) compared with a fluid liberal management strategy similar to contemporaneous practice.