Target even fluid balance for patients unless there are ongoing fluid losses (ie diarrhea) or objective evidence of hypovolemia
Use conservative fluid management when there is no evidence of shock
Use conservative fluid management strategy for ARDS patients without tissue hypoperfusion
Consider giving 250-500ml crystalloid fluid bolus as a rapid bolus in the first 15-30 minutes and reassess for signs of fluid overload after each bolus
Determine need for additional fluid boluses based on clinical response and improvement of perfusion targets (including MAP and urine output)
Administer vasopressors (norepinephrine is considered first-line) when shock persists during or after fluid resuscitation
