Comparative study between restrictive versus liberal intravenous fluid administration in severe sepsis and septic shock; a randomized clinical trial

Abstract

Sepsis is an inflammatory response to severe infection characterized by hypovolemia and vasodilation and treated with early antibiotics and fluid resuscitation. In-hospital mortality rates have decreased from 80% in the early years of intensive care to 20-30% in the modern era through improved surveillance, early treatment of underlying infection, and advances in support for failing organs. Despite the central role intravenous (IV) fluid administration has played in sepsis management for the last 15 years, fundamental questions regarding “which fluid” and “in what amount” remain unanswered. Sepsis is still a major cause of mortality over the world. Distinct phases of hemodynamic resuscitation have been described with different risks, goals, and challenges: resuscitation, optimization, stabilization, and de-escalation phases. Fluid therapy represents one of the cornerstones of resuscitation treatments in order to increase oxygen delivery during circulatory failure. During the salvation phase of septic shock, the current guidelines suggest that an aggressive fluid resuscitation is the best initial therapy. During the optimization phase, the goal is to maintain adequate tissue perfusion and avoid the effects of fluid overload. During this phase, “liberal” or uncontrolled fluid therapy can induce an increased positive fluid balance with tissue fluid overload leading to potential harmful effects. A restrictive fluid therapy strategy could be used to decrease fluid overload (FO) during the optimization phase in septic shock patients. It is worth mentioning that inappropriate use of fluid therapy can induce its own side effects.