The most substantive portion of the review considers the significance of the large and long-awaited National Heart, Lung, and Blood Institute Fluids and Catheter Treatment Trial.2The authors summarized the importance of the fluids portion of the Fluids and Catheter Treatment Trial by noting the clear benefit demonstrated by fluids restriction in ARDS patients. Not emphasized by the authors is the fact that both study cohorts, liberal fluids and restricted fluids, were necessarily, by definition, fluid-overloaded to begin the study. This can be deduced from the weight data available on ARDS patients from the ARDS Net itself. The estimated overweight condition is 20%!3 Twenty percent in the average 150-lb patient is 30 lbs, 30 pints, 15 quarts, nearly 4 gallons of retained fluid! It is further remarkable that merely holding the fluid balance “neutral” in the fluids-restricted (but overloaded) cohort resulted in statistically significant and practical benefits. These improvements were consistent with the concept of ARDS as a condition of serious overloading of the extracellular fluid space with isotonic crystalloid.