Sepsis & septic shock · How much fluid
Restriction of Intravenous Fluid in ICU Patients with Septic Shock
| Design | International, multicentre randomised controlled trial |
|---|---|
| Treatment | Restrictive intravenous fluid strategy |
| Control | Standard intravenous fluid therapy |
| Population | 1554 adults with septic shock in intensive care |
| Follow-up | 90 days |
| Primary endpoint | All-cause mortality at 90 days |
| Result | 770 patients were assigned to restrictive fluids and 784 to standard fluids, with primary outcome data for 1545 (99.4%). The restrictive group received a median of about 1798 mL in the ICU, substantially less than standard care, with no difference in 90-day mortality. Serious adverse events occurred at least once in 221 of 751 (29.4%) with restrictive fluid and 238 of 772 (30.8%) with standard fluid. |
| Secondary endpoints | Serious adverse events, days alive without life support, days alive out of hospital |
Among adult patients with septic shock in the ICU, intravenous fluid restriction did not result in fewer deaths at 90 days than standard intravenous fluid therapy.
The trial authors, in the published abstract
Fluid restriction had become fashionable on physiological grounds, and this trial found the question is less consequential than the argument suggested. CLOVERS reached the same conclusion earlier in the illness, at the point of sepsis-induced hypotension.
Meyhoff TS, Hjortrup PB, Wetterslev J, et al. Restriction of Intravenous Fluid in ICU Patients with Septic Shock. N Engl J Med 2022 Jun 30;386(26):2459-2470.