No difference in outcomes with restrictive versus liberal fluid strategy for sepsis-induced hypotension

Clinical Question

Does a restrictive fluid strategy (compared with a more liberal strategy) improve outcomes in patients with hypotension due to sepsis?

Bottom line

Treating patients with sepsis-induced hypotension with a strategy that prioritizes vasopressors and limits intravenous fluids results in similar outcomes when compared with a more liberal fluid strategy. 1b

Study design: Randomized controlled trial (nonblinded)

Funding: Government

Setting: Inpatient (any location)


Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL

Discuss this POEM


Pieter Richard Verbeek

Restrictive versus liberal fluid strategy for sepsis

Interesting study. Would have liked the reviewer to comment on type and timing of antibiotics between groups so the reader was informed whether there were any differences between groups. Significant differences could would be an important bias in outcomes. One also wonders whether even earlier fluid administration (e.g. prehospital setting) with or without antibiotics could have made a difference. After years of COVID related delays, we have now started our PITSTOP trial (NCT03068741) (Paramedic Initiated Treatment of Sepsis Targeting Out-of-hospital Patients) to answer this still unanswered question.


Impact assessment

Very good


Fluid intake not critical to sepsis treatment

Good to know