Podcast 796: Fluid Amounts in Septic Shock

<p><strong>Contributor: Aaron Lessen, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Septic shock management has traditionally endorsed rapid fluid resuscitation and the administration of vasopressors</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Current guidelines are for patients to initially receive a 30 ml/kg fluid bolus then additional fluid as needed for continued hypotension</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">The ideal volume of fluid needed to maximize patient outcomes has been debated</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">A recent ICU-based study examined mortality differences between patient receiving restricted vs standard fluid therapy for septic shock</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">There was no significant difference in the rate of mortality or adverse outcomes between the two groups indicating that the amount of fluid used after the initial bolus does not affect patient outcomes</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">More research needed to evaluate the ideal  fluid volumes used in the initial resuscitation of septic shock</span></li> </ul> <p> </p> <p><span style="font-weight: 400;">Errata: *** “The primary outcome was death within 90 days after randomization”</span></p> <p> </p> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247.</span></p> <p><span style="font-weight: 400;">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