Treating septic shock effectively with half the fluid volume

Disease and treatment 28. jul 2022 2 min Professor Anders Perner Written by Kristian Sjøgren

People hospitalised in intensive care for septic shock do just as well if they receive only half the intravenous fluid used in the standard treatment today. A researcher says that minimising fluid use can save resources, although using more fluid is not harmful to the people with septic shock.

Septic shock is a life-threatening systemic reaction resulting from severe infection. Current treatments are simple and comprises antibiotics, medication to maintain blood pressure and then intravenous fluid.

However, some studies have indicated that high volumes of intravenous fluid can harm people with septic shock and increase their risk of dying.

A new clinical trial rejects this assumption.

People do just as well if they receive half the standard amount of fluid, and using less fluid saves resources.

“Resources in healthcare should only be used when necessary, and limiting the intravenous fluid therefore makes sense. Further, our research shows that using fluid volumes within the range given in our trial appears safe,” explains a researcher behind the trial, Anders Perner, Professor, University of Copenhagen and Staff Specialist, Department of Intensive Care, Rigshospitalet, Copenhagen.

The research has been published in the New England Journal of Medicine.

42% mortality

Previous observational studies of people with septic shock indicated that using excessive fluid may be dangerous.

There has been speculation that fluid therapy leads to the accumulation of fluid in vital organs such as the gut, kidneys and lungs.

In these studies, researchers also found higher mortality among people treated with more fluid.

However, this may be confounded by the fact that severely ill people receive more fluid. The severity of their disease may therefore increase their risk of dying and not the volume of fluid.

“Sepsis treatment needs to be thoroughly overhauled. Today we use simple interventions, and the 3-month mortality rate for septic shock is still above 40%. We therefore decided to elucidate the optimal fluid therapy for septic shock, as we have done for other simple interventions,” says Anders Perner.

Quantity makes no difference

The researchers randomised 1,554 people with septic shock hospitalised in 30 intensive care units in eight countries to receive either the quantity of fluid recommended by the current guidelines or only half.

The researchers then followed these patients for 3 months and noted how many died and how many experienced serious adverse events such as ischaemia or kidney failure. The researchers also examined how many days the patients were alive without life support and out of hospital.

The outcomes were similar for using the full quantity of fluid and half as much.

  • The same percentage died within 3 months in both fluid groups: 42%.
  • 29% of those receiving half the quantity of fluid experienced serious adverse events versus 31% of those receiving the full quantity.
  • Both groups had similar numbers of days alive without life support and out of the hospital.

“These results are reassuring because they show that receiving the full or half dose of fluid does not matter. Both approaches are safe as long as the patients receive fluid within the range we used,” explains Anders Perner.

Money saved can be used elsewhere

Anders Perner says that even though the outcomes did not differ, the results should still change the standard treatment to save resources.

Healthcare systems everywhere are struggling to use money efficiently, and using fewer resources, including intravenous fluids, can save money.

Fluid therapy is relatively inexpensive but still requires human resources for nurses and resources to sterilise the liquid, produce the fluid bags and dispose of waste.

“Healthcare should use resources where they benefit people the most, and we showed that providing more fluid does not benefit anyone. We should save these resources and use them elsewhere,” concludes Anders Perner.

Restriction of intravenous fluid in ICU patients with septic shock” has been published in the New England Journal of Medicine. The Novo Nordisk Foundation has awarded grants to Anders Perner: one in 2017 for the project Effects of Restricting Intravenous Fluids on Patient-important Outcome Measures in Patients with Septic Shock – the Conservative versus Liberal Approach to Fluid Therapy of Septic Shock in Intensive Care (CLASSIC) Trial; and another in 2019 for the project IMPROVE-ICU – Improving Intensive Care through Clinical Trials. The studies received additional support from Læge Sofus Carl Emil Friis og Hustru Olga Doris Friis’ Legat, Research Council of Rigshospitalet and Danish Society of Anaesthesiology and Intensive Care Medicine.

Anders Perner is a senior staff specialist in Intensive Care, Rigshospitalet and professor in intensive care at Copenhagen University Hospital. He cha...

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