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Restrictive, Liberal Fluid Strategies Yield Similar Outcomes for Sepsis-Induced Hypotension

All-cause death before discharge home by day 90 occurred in 14.0 percent of the restrictive fluid group and 14.9 percent in the liberal fluid group

By Lori Solomon HealthDay Reporter

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 annual Critical Care Congress, held from Jan. 21 to 24 in San Francisco.

Nathan I. Shapiro, M.D., and colleagues from the U.S. 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 (prioritizing vasopressors and lower intravenous fluid volumes) or a liberal fluid strategy (prioritizing higher volumes of intravenous fluids before vasopressor use) for a 24-hour period 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), whereas the restrictive fluid group had earlier, more prevalent, and longer duration of vasopressor use. All-cause death before discharge home by 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 occurrences of complications (extravasation that resolved without intervention or clinical consequence) among 500 patients who received vasopressors through 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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