Objectives 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. Design 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. Setting ICUs of Acute Respiratory Distress Syndrome Network participating hospitals. Patients Five hundred three subjects managed with FACTT Conservative, 497 subjects managed with FACTT Liberal, and 1,124 subjects managed with FACTT Lite. Interventions Fluid management by protocol. Measurements and Main Results 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 (p < 0.001). 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, p < 0.001 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). Conclusions 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.

Implementation of an OU-HOT protocol for patients with bronchiolitis safely reduces hospital LOS with significant cost savings. Although widespread implementation has the potential for dramatic cost savings nationally, further studies assessing overall health care use and cost, including the impact on families and outpatient practices, are needed.

We all remember the famous line from Indiana Jones and the Last Crusade, uttered by the Grail Knight deep inside a Middle Eastern cave after Indiana (Harrison Ford) drank from the carpenter's chalice: "you have chosen…wisely."

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CORRESPONDENCE. [TMC 1025 DIATHERMY ENIUCLEATION OF TONSILS. SIR,-It is an aincient but discredited method in coiitroversy to wrench from writings such itemns as suit us, and to leave those that militate against us discreetly alon.e. Trliis is what Dr. Warnier Collinis has done in his letter disag,-eeinig with my warninig about too extenisive diathermy (ioagulation of the tonsil at one sitting. May I suggest to hiim that he turn once m-iiore to my book on Diathernmy and readl the sections dealiiig with this subject in their entirety, dwelling particularly upon page 66, line 1 et seq., and pages 74 and 75?-I am, etc., London, W.1, Dec. 6th. DAN MCKENZIE. MIGRAINE. SIR,-As one who lhas studied migraine (Iiemicrania) for many years, may I remark oni the discussion on the treatment of headache whicli took place at the Novemiiber mlleetiiig of tlhe Chelsea Clinical Societv (British Medical Jeolor,ud(i, Nov-emiber 29th, p. 907)? Douibtless this was an iniformial discussion," but I was a little surprised to find jno reference in the report to the periodicity of hemicrania. Thiis weekly, fortnightlv, monthly, or other rhythm of