There is no mortality difference between restrictive fluid strategy and liberal fluid strategy in septic patients

  • early study in 2013 found increased mortality with patients having high positive fluid balance. 1

Meta analysis

Meta analysis in 2020 showing liberal fluid therapy has worsening outcome.2

Classic trial

Published 6/2022.

Restrictive strategy (no fluid unless hypoperfusion) compared to liberal strategy (no upper limit of fluids) did not show improved mortality benefit.

Patients both received median 3 L prior to randomization. Total difference in fluid by day 5 was similar in both group (8.8L vs 10.8L).3

Clovers trial

Published Clovers trial 2/2023

In patients with sepsis induced hypotension, a restrictive fluid strategy (total up to 2L including pre-randomization) does not improve mortality, ventilator free days, days out of ICU, new intubation, new ARDS compared to liberal fluid strategy (immediate 2L at randomization after 1-3L pre-randomization and then 500 cc bolus PRN, with rescue vasopressor to be given after 5L total).

Patients with restrictive fluid strategy had higher ICU admission rates.4

Footnotes

  1. Micek ST, McEvoy C, McKenzie M, Hampton N, Doherty JA, Kollef MH. Fluid balance and cardiac function in septic shock as predictors of hospital mortality. Crit Care. 2013 Oct 20;17(5):R246. doi: 10.1186/cc13072. PMID: 24138869; PMCID: PMC4056694. ↩

  2. Meyhoff TS, Møller MH, Hjortrup PB, Cronhjort M, Perner A, Wetterslev J. Lower vs Higher Fluid Volumes During Initial Management of Sepsis: A Systematic Review With Meta-Analysis and Trial Sequential Analysis. Chest. 2020;157(6):1478-1496. doi:10.1016/j.chest.2019.11.050 ↩

  3. Classic trial: https://www.thebottomline.org.uk/summaries/icm/classic-trial/ ↩

  4. Clover trial: https://www.thebottomline.org.uk/summaries/icm/clovers/ ↩