by Corl, Keith A.; Prodromou, Michael; Merchant, Roland C.;
Gareen, Ilana; Marks, Sarah; Banerjee, Debasree; Amass, Timothy; Abbasi, Adeel;
Delcompare, Cesar; Palmisciano, Amy; Aliotta, Jason; Jay, Gregory; Levy, Mitchell
M.
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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