Clinical

Restrictive IV fluid strategy comparable to usual care for severe sepsis, septic shock


 

Background: Since the advent of early goal-directed therapy (EGDT), studies have challenged the notion that high-volume IV fluid resuscitation improves clinical outcomes in sepsis and septic shock. The optimal IV fluid resuscitation strategy for severe sepsis and septic shock remains unclear.

Study design: Prospective randomized controlled trial.

Setting: Two critical care units in one academic system.

Synopsis: The Restrictive IV Fluid Trial in Severe Sepsis and Septic Shock (RIFTS) randomized 109 participants ages 54-82 years to a restrictive (less than 60 mL/kg) or to usual care (no prespecified limit) IV fluid resuscitation strategy for the first 72 hours of ICU admission. The primary outcome of 30-day mortality was similar between groups (odds ratio, 1.02; 95% confidence interval, 0.41-2.53).

Limitations to RIFTS include its small sample size, single-system design, and inadequate power to detect noninferiority or superiority. While larger, multicenter trials are required for further investigation, hospitalists should note a trend toward conservative IV fluid administration in severe sepsis and septic shock.

Bottom line: Restrictive IV fluid resuscitation for severe sepsis and septic shock may result in mortality rates similar to those of usual care, but larger, multicenter studies are needed to confirm noninferiority.

Citation: Corl KA et al. The restrictive IV fluid trial in severe sepsis and septic shock (RIFTS): A randomized pilot study. Crit Care Med. 2019;47(7):951-9.

Dr. McIntyre is a hospitalist at Ochsner Health System, New Orleans.

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