No Benefit to Restrictive Fluid Resuscitation of Patients with Septic Shock

More than 2 decades ago, early goal-directed therapy was introduced as a strategy to treat patients with sepsis and septic shock. We subsequently learned that protocolized care did not save lives, and concerns increased about potential harm from excessive fluid resuscitation. Debate continues about how much is “enough” fluid before initiating vasopressors for septic shock.

In a multicenter U.S. trial, investigators randomized more than 1500 patients with septic shock (almost all in the emergency department) to either liberal or restrictive fluid resuscitation. All patients received at least 1 L of crystalloid before randomization (median, 2 L). Subsequently, for systolic blood pressure <100 mm Hg or mean arterial pressure <65 mm Hg, patients…