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An initial fluid bolus of 30 ml/kg for patients with sepsis is a Surviving Sepsis Campaign weak recommendation, but its adoption as a quality metric has made it near-universal practice in U.S. emergency departments (EDs). After administering 30 ml/kg of IV fluid, most clinicians will initiate vasopressor therapy in patients who remain hypotensive. However, some have argued that rapid infusion of so much fluid could be harmful and suggest that instead vasopressor be initiated earlier in patients with sepsis and shock.
In this trial, investigators enrolled 1000 ED patients in septic shock who remained hypotensive despite receiving fluid boluses totaling at least 1000 ml (median, 18 ml/kg). Then, they were randomized to either immediate …