The following is a summary of “Impact on fluid balance of an optimized restrictive strategy targeting non-resuscitative fluids in intensive care patients with septic shock: a single-blind, multicenter, randomized, controlled, pilot study,” published in the December 2024 issue of Critical Care by Boulet et al. 

Researchers conducted a retrospective study to investigate the effectiveness of a restrictive fluid strategy in limiting daily volume during septic shock management.  

They included individuals aged 18–85 years with septic shock within the first 24 hours of vasopressor infusion, admitted to the ICU at 3 French hospitals. Exclusion criteria included acute kidney injury requiring renal replacement therapy, end-stage chronic kidney disease, and severe malnutrition. Participants were randomized electronically (1:1) to an optimized fluid restriction group, which minimized maintenance fluids and drug dilution over 7 days, or to a standard fluid strategy group. The primary outcome measured was cumulative fluid balance (ml/kg) over the first 5 days. Patients and statisticians were blinded to group arm, but clinicians were not.  

The results showed between September 2021 and February 2023, 1,201 patients were screened, with 50 included, 2 participants withdrew from the control group, leaving 48 patients (24 in each group) for analysis. In the initial 5 days, the optimized restrictive strategy group received 89.7 (IQR 35; 128.9) ml/kg, while the control group received 114.3 (IQR 78.8; 168.5) ml/kg (mean difference: 35.9 ml/kg [0.0; 71.8], P = 0.0506). After 5 days, the median cumulative fluid balance was 6.9 (IQR −13.7; 52.1) ml/kg in the optimized strategy group and 35.0 (IQR −7.9; 40.2) ml/kg in the control group (absolute difference: 13.2 [95% CI −15.2; 41.6], P = 0.42). At 28 days, mortality and days alive without life support were similar between the groups. The main adverse events included severe hypernatremia in 1 and 2 patients in the restrictive and control groups, respectively, and acute kidney injury (KDIGO 3) in 4 and 7 patients, respectively.  

Investigators concluded an optimized restrictive fluid strategy targeting hidden fluid intakes did not reduce overall fluid balance by day 5 in patients with septic shock admitted to ICU.  

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05155-z