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Cited by 6Sepsis Diagnosis and TreatmentHemodynamic Monitoring and TherapyAbdominal Surgery and Complications

Fluids or vasopressors for the initial resuscitation of septic shock

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Macdonald, Stephen, Peake, Sandra L., Corfield, Alasdair R., Delaney, Anthony·2022·Frontiers in Medicine
DOI 10.3389/fmed.2022.1069782PMC PMC9729725
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Abstract

Intravenous fluid resuscitation is recommended first-line treatment for sepsis-associated hypotension and/or hypoperfusion. The rationale is to restore circulating volume and optimize cardiac output in the setting of shock. Nonetheless, there is limited high-level evidence to support this practice. Over the past decade emerging evidence of harm associated with large volume fluid resuscitation among patients with septic shock has led to calls for a more conservative approach. Specifically, clinical trials undertaken in Africa have found harm associated with initial fluid resuscitation in the setting of infection and hypoperfusion. While translating these findings to practice in other settings is problematic, there has been a re-appraisal of current practice with some recommending earlier use of vasopressors rather than repeated fluid boluses as an alternative to restore perfusion in septic shock. There is consequently uncertainty and variation in practice. The question of fluids or vasopressors for initial resuscitation in septic shock is the subject of international multicentre clinical trials.

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  • In a clinical trial completed in Africa, aggressive fluid strategies for septic patients were associated with worsening respiratory status and mortality.

    “In a clinical trial completed in Africa, aggressive fluid strategies for septic patients were associated with worsening respiratory status and mortality, underscoring that one-size-fits-all approach should not be standard practice [21].”

    From Artificial Intelligence to Facilitate SEP-1 Measure Compliance and Fluid Management in Sepsis (2026) · cites this paper as [21]

    The “Evidence of harm with fluids” section reports that two trials in Africa found higher mortality among septic patients receiving larger IV fluid volumes. It does not report worsening respiratory status in those trials; it says the excess mortality was due to persistent shock. The paper also cautions against directly applying those results to high-income settings. (LLM, conf=0.88)

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Cited by

Sorted by citations

Authors
Macdonald, S., Peake, S. L., Corfield, A. R., & Delaney, A.
Affiliations
  • The University of Western Australia (AU)
  • Queen Elizabeth Hospital (AU)
  • NHS Greater Glasgow and Clyde (GB)
  • The University of Sydney (AU)
Corresponding author
Macdonald, Stephen
ORCID
Venue
Frontiers in Medicine
Publisher
Frontiers Media SA
Published
2022-11-24
Volume
9
Pages
1069782-1069782
ISSN
2296-858X (ISSN-L)
DOI
10.3389/fmed.2022.1069782
PMC
PMC9729725
OpenAlex
W4309844100
Cited by
6
References
5
Citations by year
2026: 4 · 2025: 2
FWCI
0.08
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
  • UWA Profiles and Research Repository (UWA) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
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
septic shock, fluid resuscitation, vasopressors, sepsis, hypotension, hypoperfusion, clinical practice variation, sepsis treatment guidelines

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