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PACU Literature Review #14. Restriction of Intravenous Fluid in ICU Patients with Septic Shock

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Meyhoff TS, Hjortrup PB, Wetterslev J, et al. Restriction of intravenous fluid in icu patients with septic shock. N Engl J Med. 2022;386(26):2459-2470.
PMID: 3 35709019


  • To determine if a restricted fluid strategy had an impact on mortality in patients with septic shock


  • Stratified, parallel-group, open label, randomized clinical trial in 31 ICUs in eight countries

Study Intervention & Comparison

  • Restrictive* IV fluid group vs standard IV fluid group
  • *Fluids only allowed in cases of hypoperfusion, documented fluid loss, dehydration, or to a minimum of 1L per day


  • Primary Outcome
    • Death occurred in 42.3% of patients in the restrictive group vs 42.1% in the standard group (-0.1 percentage points, p=0.96)
  • Secondary Outcomes
    • No difference in major adverse events (29.4% vs 30.8%) or numbers of days alive without life support or days alive and out of the hospital at 90 days
    • No heterogeneity in the primary outcome based on respiratory support, AKI, lactate, body weight, or receipt of 30mL/kg bolus prior to randomization


  • Among adult patients in the ICU, intravenous fluid restriction did not result in fewer deaths at 90 days than standard IV fluid therapy.

Additional Readings

  • Corl KA, Prodromou M, Merchant RC, et al. The Restrictive IV Fluid Trial in Severe Sepsis and Septic Shock (RIFTS): A Randomized Pilot Study Crit Care Med. 2019;47(7):951-959.
  • Boyd JH, Forbes J, Nakada T aki, Walley KR, Russell JA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011;39(2):259-265.
  • Meyhoff TS, Møller MH, Hjortrup PB, Cronhjort M, Perner A, Wetterslev J. Lower vs higher fluid volumes during initial management of sepsis: a systematic review with meta-analysis and trial sequential analysis. Chest. 2020;157(6):1478-1496.