Restrictive fluid resuscitation in septic shock patients has lower mortality and organ dysfunction rates than standard therapy

Abstract

Abstract Background The influence of restrictive fluid resuscitation and the early administration of vasopressors on the clinical outcomes in patients with septic shock is not fully understood. The purpose of this study was to evaluate the effects of restrictive fluid management on mortality and organ dysfunction in patients with septic shock. Methods This study included consecutive patients with septic shock in need of fluid resuscitation. Based on the fluid management provided in the initial resuscitation phase, a comparison was made between a restrictive group and a standard fluid management group. The primary outcome was in-hospital death, while secondary outcomes included organ dysfunction and other adverse events. Results A total of 238 patients were included in this study. Restrictive fluid management was administered to 59.2% of patients, while 40.8% received standard fluid management. Restrictive resuscitation was associated with a lower in-hospital mortality rate (24.8% vs. 52.6%), as well as a shorter median ICU stay (8.0 vs. 11.0 days). The restrictive strategy was associated with a significantly lower prevalence of new-onset acute kidney injury (25.5% vs. 51.5%) and a decrease in the incidence of renal replacement therapy (20.6% vs. 40.2%). The standard group had a higher risk of the need for mechanical ventilation and a significantly lower median number of days without a ventilator than the restrictive group. The median duration of vasopressor-free days in the restrictive group was significantly longer than that in the standard group (25.0 vs. 18.0). The administration rate of inotropes in the restrictive group was significantly lower than that in the standard group. A multivariate logistic regression model showed that restrictive fluid management (OR 0.312; 95% CI 0.098–0.994) and vasopressor-free days (OR 0.807; 95% CI 0.765–0.851) protect against in-hospital death, whereas APACHE II scores (OR 1.121; 95% CI 1.018–1.234) were independent risk factors for in-hospital death. Conclusions Restrictive fluid resuscitation and early vasopressor protocol in patients with septic shock are associated with better outcomes, indicating that this regimen is feasible and safe.