Sepsis & septic shock · How much fluid
Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Restrictive fluid strategy with earlier vasopressor use |
| Control | Liberal fluid strategy |
| Population | 1563 patients with sepsis-induced hypotension |
| Follow-up | 90 days |
| Primary endpoint | Death from any cause before discharge home by day 90 |
| Result | 782 patients were assigned to restrictive fluids and 781 to liberal fluids. Resuscitation therapies during the 24-hour protocol period differed clearly between the groups, with no significant difference in mortality before discharge home by day 90. |
| Secondary endpoints | Ventilator-free days, vasopressor-free days, renal replacement therapy |
Among patients with sepsis-induced hypotension, the restrictive fluid strategy that was used in this trial did not result in significantly lower (or higher) mortality before discharge home by day 90 than the liberal fluid strategy.
The trial authors, in the published abstract
The authors' parenthetical — 'or higher' — is the point. Within the ranges these trials tested, fluid strategy simply does not determine survival, and clinicians can reasonably individualise. Concordant with CLASSIC later in the illness.
Shapiro NI, Douglas IS, Brower RG, et al. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med 2023 Feb 9;388(6):499-510.