Restrictive, Liberal Fluid Strategies Yield Similar Outcomes for Sepsis-Induced Hypotension – Consumer Health News


WEDNESDAY Jan 25 2023 (HealthDay News) — A restrictive fluid strategy does not significantly improve mortality among patients with sepsis-induced hypotension, according to a study published online Jan. 21 in the New England Journal of Medicine to coincide with the Society of Critical Care Medicine’s annual Critical Care Congress, held Jan. 21-24 in San Francisco.

Nathan I. Shapiro, MD, and colleagues from the US National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network, randomly assigned 1,563 patients with sepsis-induced hypotension to either a restrictive fluid strategy (give priority to vasopressors and lower intravenous fluid volumes) or a liberal fluid strategy (prioritizing larger volumes of intravenous fluid before using a vasopressor) for a period of 24 hours after the initial administration of one to three liters of intravenous fluid.

The researchers reported that less intravenous fluid was administered in the restrictive fluid group versus the liberal fluid group (difference of medians, -2,134 mL), while the restrictive fluid group had earlier, more frequent, and longer vasopressor use. Death from all causes before discharge home on day 90 occurred in 14.0 percent of the restrictive fluid group and 14.9 percent in the liberal fluid group, with serious adverse events also similar between the two groups.

“The presence of only three cases of complications (extravasation that resolved without intervention or clinical sequelae) in 500 patients who received vasopressors via a peripheral catheter provides data supporting the safety of this practice,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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