CLASSIC

Restriction of Intravenous Fluid in ICU Patients with Septic Shock

Meyhoff T. NEJM 2022; DOI: 10.1056/NEJMoa2202707

Clinical Question

• In adult patients in ICU with septic shock, does a restrictive approach to fluid therapy compared to a standard care result in fewer deaths at day 90?

N = 1554, 31 ICUs in Europe

Authors’ Conclusions

• In adult ICU patients with septic shock, IV fluid restriction did not result in fewer deaths at 90 days compared to standard IV fluid therapy

The Bottom Line
-  This study did not confirm my pre-existing biases, in that a restrictive fluid strategy was not shown to be superior, with respect to 90 day mortality, to standard fluid management currently being practiced in European ICUs

• However, the 5 day cumulative fluid balance in the standard group was not much greater than the restrictive group. Therefore care is still required to ensure that every patient in ICU has a vigilant and considered fluid management strategy. This includes the de-escalation or evacuation phase of fluid therapy.