A restrictive fluid strategy does not significantly improve mortality among patients with sepsis-induced hypotension, according to a study published in the New England Journal of Medicine. Wesley H. Self, MD, MPH, and colleagues randomly assigned 1,563 patients with sepsis-induced hypotension to either a restrictive fluid strategy (prioritizing vasopressors and lower IV fluid volumes) or a liberal fluid strategy (prioritizing higher volumes of IV fluids before vasopressor use) for 24 hours after the initial administration of 1-3 liters of IV fluid. Less IV fluid was administered in the restrictive fluid group versus the liberal fluid group
(difference of medians, −2,134 mL), whereas the restrictive fluid group had earlier, more prevalent, and longer vasopressor use. All-cause death before discharge home by day 90 and serious adverse events were similar between groups. “The presence of only three occurrences of complications (extra-vasation that resolved without intervention or clinical consequence) among 500 patients who received vasopressors through a peripheral catheter provides data supporting the safety of this practice,” Dr. Self and colleagues wrote.