Restrictive Fluid Resuscitation in Septic Shock Patients has Lower Mortality and Organ Dysfunction Rates than Standard Therapy

Restrictive Fluid Resuscitation in Septic Shock Patients has Lower Mortality and Organ Dysfunction Rates than Standard Therapy

Authors: Zhizhao Jiang, Fenbin Luo, Yuqi Liu, Xuri Sun, Guoliang Tan, Zhiliang Chen, Yongqiang Chen

Published in: Shock, 2023 November 11

Conclusions:

  • Restrictive fluid resuscitation combined with early vasopressor administration in septic shock patients is associated with improved outcomes, suggesting it as a feasible and safe approach.

Methods:

  • This study analyzed consecutive septic shock patients requiring fluid resuscitation.
  • Patients were divided into two groups based on initial fluid management: restrictive fluid resuscitation and standard fluid management.
  • Primary outcome: in-hospital mortality.
  • Secondary outcomes: organ dysfunction and other adverse events.

Results:

  • The study included 238 patients: 59.2% received restrictive fluid management, while 40.8% underwent standard fluid management.
  • Key findings:
    • Lower in-hospital mortality in the restrictive group (24.8% vs. 52.6%).
    • Shorter median ICU stay in the restrictive group (8.0 vs. 11.0 days).
    • Lower incidence of new-onset acute kidney injury (AKI) in the restrictive group (25.5% vs. 51.5%).
    • Decreased need for renal replacement therapy in the restrictive group (20.6% vs. 40.2%).
    • Lower need for mechanical ventilation and more ventilator-free days in the restrictive group.
    • Longer vasopressor-free duration in the restrictive group (25.0 vs. 18.0 days).
    • Lower inotrope administration in the restrictive group.
  • Multivariate logistic regression identified restrictive fluid management (OR 0.312; 95% CI 0.098-0.994) and vasopressor-free days (OR 0.807; 95% CI 0.765-0.851) as protective against in-hospital death, while APACHE II scores were risk factors for in-hospital death (OR 1.121; 95% CI 1.018-1.234).

Jiang, Z., Luo, F., Liu, Y., Sun, X., Tan, G., Chen, Z. and Chen, Y., 2023. Restrictive fluid resuscitation in septic shock patients has lower mortality and organ dysfunction rates than standard therapy. Shock, pp.10-1097.

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