RCT Results: Does Restricting IV Fluid Volume Improve Septic Shock Outcomes?
BACKGROUND AND PURPOSE:
Patients in septic shock are usually given IV, but high volumes may be associated with worse outcomes including kidney injury, respiratory failure, and higher risk of death
Meyhoff et al. (NEJM, 2022) evaluated the effects of IV fluid restriction on mortality and other outcomes in adult patients with septic shock
International, open-label randomized trial
Conservative versus Liberal Approach to Fluid Therapy of Septic Shock in Intensive Care (CLASSIC) trial
In ICU with septic shock
Had received ≥1 liter of IV fluid
Patients were included if the onset of shock had been ≤12 hours of screening
Restricted IV fluid therapy: 250 to 500 ml IV bolus of isotonic crystalloid (saline or buffered solutions) | Fluid losses (e.g., GI drains) could be replaced | Dehydration or electrolyte deficiency could be corrected | Additional IV fluid provided for a total daily fluid intake of 1 liter
Standard IV fluid therapy: No upper limit | IV fluid given as long as the patient had improvement in hemodynamic factors | Replacement of expected or observed losses or to correct dehydration or electrolyte derangements | Maintenance based on local ICU protocol
Death from any cause within 90 days of randomization
Restricted fluid: 770 patients | Standard fluid: 784 patients
Intravenous fluid volume received
Restricted fluid group: median 1798 (IQR, 500 to 4366) mL
Standard fluid group: median 3811 (IQR, 1861 to 6762) mL
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan