Conservative Fluid Management After Sepsis Resuscitation: A Pilot Randomized Trial
Open accessAbstract
Rationale: The feasibility and clinical outcomes of conservative fluid management after sepsis resuscitation remain unknown. Objectives: To evaluate the effect of a conservative fluid management protocol on fluid balance and intensive care unit (ICU)-free days among patients with sepsis. Methods: In a single-center phase II/III randomized trial, we enrolled adults with suspected infection, ≥2 systemic inflammatory response syndrome criteria, and either shock (mean arterial pressure <60 mm Hg or vasopressors) or respiratory insufficiency (mechanical ventilation or oxygen saturation <97% and fraction of inspired oxygen ≥0.3). Patients were randomized 1:1 to usual care or a conservative fluid management protocol. The protocol restricted intravenous fluid administration during shock to treatment of oliguria or increasing vasopressor requirement. In the absence of shock, loop diuretic infusion targeted equal fluid input and output each study day. The primary outcomes were mean daily fluid balance (phase II) and ICU-free days (phase III). Results: At the completion of phase II (n = 30), the difference in mean daily fluid balance between groups (−398 mL) was less than the prespecified threshold (−500 mL) and the trial was stopped. Patients in the conservative fluid management (n = 15) and usual care (n = 15) groups experienced similar cumulative fluid input (8450 mL vs 7049 mL; P = .90) of which only 14% was intravenous crystalloid or colloid. Loop diuretic infusion occurred more frequently in the conservative fluid management group (40% vs 0%; P = .02), and cumulative fluid output was 10 645 mL in the conservative fluid management group compared to 6286 mL in the usual care group ( P = .39). Hemodynamic, respiratory, and renal function did not differ between the groups. Conclusions: In this phase II trial, a conservative fluid management protocol did not decrease mean daily fluid balance by more than 500 mL among patients with sepsis. Registration: Clinicaltrials.gov ; NCT02159079.
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Limited data on cost-effectiveness are available, although a single-center study reported decreased hospital costs associated with PCT-guided antibiotic use in medical ICU patients with undifferentiated sepsis.
“Limited data on the cost-effectiveness are available, although a single-center study reported decreased hospital costs associated with PCT-guided antibiotic in medical ICU patient with undifferentiated sepsis (323).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [323]
The Methods (Patient Population) describe a single-center medical ICU study, but the Discussion identifies its intervention as conservative fluid management after sepsis resuscitation. Searches for PCT-guided antibiotics, hospital costs, and cost-effectiveness found no passage addressing the claimed cost reduction. The shared setting does not establish the attributed finding. (LLM, conf=0.78)
Experimental — accuracy not yet measuredThe 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 [401]
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- Authors
- Semler, M. W., Janz, D. R., Casey, J. D., Self, W. H., & Rice, T. W.
- Affiliations
- Vanderbilt University Medical Center (US)
- Louisiana State University (US)
- Corresponding author
- Semler, Matthew W.
- Venue
- Journal of Intensive Care Medicine
- Publisher
- SAGE Publications
- Published
- 2019-01-10
- Volume
- 35
- Issue
- 12
- Pages
- 1374-1382
- ISSN
- 0885-0666 (ISSN-L)
- 1525-1489
- PMC
- PMC6620161
- OpenAlex
- W2909812503
- Cited by
- 38
- References
- 36
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 7 · 2023: 6 · 2022: 2 · 2021: 4 · 2020: 5
- FWCI
- 2.09
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Intensive Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K23HL143053)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Keywords
- sepsis, conservative fluid management, fluid balance, sepsis resuscitation, loop diuretics, fluid restriction, ICU-free days, shock, respiratory failure, vasopressors, oliguria
- MeSH terms
- Crystalloid Solutions, Aged, Female, Fluid Therapy, Humans, Male, Middle Aged, Pilot Projects, Resuscitation, Sepsis
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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