Fluid Management Strategies in Early Sepsis and Septic Shock: A Systematic Review of Restrictive versus Liberal Approaches

Abstract

Introduction: Intravenous fluid resuscitation is a cornerstone of sepsis management, but the optimal volume and strategy remain unclear. This review compares the effects of a restrictive versus a liberal fluid strategy on outcomes in patients with sepsis.

Methods: A search of MEDLINE and CENTRAL was conducted for RCTs comparing a protocolized restrictive fluid strategy to a liberal or standard care fluid strategy in adult patients with sepsis or septic shock. The primary outcome was all-cause mortality.

Results: The meta-analysis of five large RCTs showed no significant difference in all-cause mortality at 90 days between restrictive and liberal fluid strategies. Patients in the restrictive fluid group received significantly less fluid, had a lower incidence of fluid overload, and required less respiratory support.

Discussion: A restrictive fluid strategy appears to be as safe as a liberal strategy regarding mortality and may offer benefits in reducing the harms associated with fluid overload. This supports a more cautious and individualized approach to fluid administration after initial resuscitation.

Conclusion: In patients with sepsis, a restrictive fluid strategy does not differ from a liberal strategy in mortality and may reduce iatrogenic harm.