The Restrictive IV Fluid Trial in Severe Sepsis and Septic Shock (RIFTS): A Randomized Pilot Study*
Open accessAbstract
Objectives: It is unclear if a low- or high-volume IV fluid resuscitation strategy is better for patients with severe sepsis and septic shock. Design: Prospective randomized controlled trial. Setting: Two adult acute care hospitals within a single academic system. Patients: Patients with severe sepsis and septic shock admitted from the emergency department to the ICU from November 2016 to February 2018. Interventions: Patients were randomly assigned to a restrictive IV fluid resuscitation strategy (≤ 60 mL/kg of IV fluid) or usual care for the first 72 hours of care. Measurements and Main Results: We enrolled 109 patients, of whom 55 were assigned to the restrictive resuscitation group and 54 to the usual care group. The restrictive group received significantly less resuscitative IV fluid than the usual care group (47.1 vs 61.1 mL/kg; p = 0.01) over 72 hours. By 30 days, there were 12 deaths (21.8%) in the restrictive group and 12 deaths (22.2%) in the usual care group (odds ratio, 1.02; 95% CI, 0.41–2.53). There were no differences between groups in the rate of new organ failure, hospital or ICU length of stay, or serious adverse events. Conclusions: This pilot study demonstrates that a restrictive resuscitation strategy can successfully reduce the amount of IV fluid administered to patients with severe sepsis and septic shock compared with usual care. Although limited by the sample size, we observed no increase in mortality, organ failure, or adverse events. These findings further support that a restrictive IV fluid strategy should be explored in a larger multicenter trial.
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The current evidence evaluating a restrictive IV fluid strategy in septic patients varies in inclusion criteria, definitions of restrictive and liberal strategies, criteria for additional fluids, and duration of interventions.
“The current evidence evaluating a restrictive IV fluid strategy in the management of septic patients varies with respect to the inclusion criteria, the definition of restrictive and liberal fluid strategies, the criteria guiding the administration of additional IV fluids (e.g., perfusion parameters vs. haemodynamic variables), and the duration of the interventions [397–401].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [398]
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- Authors
- Corl, K. A., Prodromou, M., Merchant, R. C., Gareen, I., Marks, S., Banerjee, D., Amass, T., Abbasi, A., Delcompare, C., Palmisciano, A., Aliotta, J., Jay, G., & Levy, M. M.
- Affiliations
- Brown University (US)
- Brigham and Women's Hospital (US)
- ORCID
- Venue
- Critical Care Medicine
- Published
- 2019-07
- Volume
- 47
- Issue
- 7
- Pages
- 951-959
- ISSN
- 0090-3493 (ISSN-L)
- PMC
- PMC6579683
- OpenAlex
- W2939690307
- Cited by
- 116
- References
- 28
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 13 · 2023: 19 · 2022: 14 · 2021: 22 · 2020: 20 · 2019: 7
- FWCI
- 11.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of General Medical Sciences (L30 GM129773)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- restrictive fluid resuscitation, septic shock, severe sepsis, intravenous fluid therapy, volume of fluid, mortality, organ failure, intensive care unit
- MeSH terms
- Aged, Aged, 80 and over, Female, Fluid Therapy, Humans, Male, Middle Aged, Pilot Projects, Prospective Studies, Shock, Septic, Comorbidity, Sepsis
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