The following is a summary of “Protocolized reduction of non-resuscitation fluids versus usual care in septic shock patients (REDUSE): a randomized multicentre feasibility trial,” published in the May 2024 issue of Critical Care by Lindén et al.
A previous study showed that most fluids administered to patients with septic shock in the ICU are non-resuscitation fluids.
Researchers conducted a retrospective multicenter trial to assess if a restrictive protocol for non-resuscitation fluids lowers total administered volume compared to standard care.
They enrolled adult patients with septic shock in six Swedish ICUs, randomizing them within 12 hours of ICU admission to either receive a protocolized reduction of non-resuscitation fluids or usual care. The primary endpoint was the total volume of fluid administered within three days of enrollment.
The results showed that the median total volume of fluid administered in the first three days was 6,008 ml (IQR 3960–8123) in the restrictive fluid group (n = 44) and 9,765 ml (IQR 6804–12,401) in the control group (n = 48). This resulted in a Hodges–Lehmann median difference of 3,560 ml [95% CI 1614–5302]; P<0.001). Data on all-cause deaths, days alive and free of MV and AKI injury or ischemic events in the ICU within 90 days of inclusion were available for 98/98 (100%), 95/98 (98%), and 95/98 (98%) of participants. At six months, cognition and health-related quality of life were assessed for 39/52 (75%) and 41/52 (79%) of surviving participants, respectively. Out of 134 eligible patients, 90 (67%) were randomized, and 15/98 (15%) participants experienced at least one protocol violation.
Investigators found a significant reduction in fluid administration with a protocol for reduced non-resuscitation fluids in patients with septic shock. This supports the feasibility of a larger trial to assess clinical outcomes.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04952-w