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Intensive Care Med. 2016 Nov;42(11):1695-1705. Epub 2016 Sep 30.

Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial.

Author information

1
Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
2
Department of Intensive Care, Randers Hospital, Randers, Denmark.
3
Department of Intensive Care, Aalborg University Hospital, Aalborg, Denmark.
4
Department of Intensive Care, Herning Hospital, Herning, Denmark.
5
Department of Intensive Care, Helsinki University Hospital, Helsinki, Finland.
6
Department of Intensive Care, Holbæk Hospital, Holbæk, Denmark.
7
Department of Intensive Care, Holstebro Hospital, Holstebro, Denmark.
8
Department of Intensive Care, Nordsjællands Hospital, Hillerød, Denmark.
9
Department of Intensive Care, Herlev Hospital, Herlev Municipality, Denmark.
10
Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
11
Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. anders.perner@regionh.dk.
12
Centre for Research in Intensive Care, Copenhagen, Denmark. anders.perner@regionh.dk.

Abstract

PURPOSE:

We assessed the effects of a protocol restricting resuscitation fluid vs. a standard care protocol after initial resuscitation in intensive care unit (ICU) patients with septic shock.

METHODS:

We randomised 151 adult patients with septic shock who had received initial fluid resuscitation in nine Scandinavian ICUs. In the fluid restriction group fluid boluses were permitted only if signs of severe hypoperfusion occurred, while in the standard care group fluid boluses were permitted as long as circulation continued to improve.

RESULTS:

The co-primary outcome measures, resuscitation fluid volumes at day 5 and during ICU stay, were lower in the fluid restriction group than in the standard care group [mean differences -1.2 L (95 % confidence interval -2.0 to -0.4); p < 0.001 and -1.4 L (-2.4 to -0.4) respectively; p < 0.001]. Neither total fluid inputs and balances nor serious adverse reactions differed statistically significantly between the groups. Major protocol violations occurred in 27/75 patients in the fluid restriction group. Ischaemic events occurred in 3/75 in the fluid restriction group vs. 9/76 in the standard care group (odds ratio 0.32; 0.08-1.27; p = 0.11), worsening of acute kidney injury in 27/73 vs. 39/72 (0.46; 0.23-0.92; p = 0.03), and death by 90 days in 25/75 vs. 31/76 (0.71; 0.36-1.40; p = 0.32).

CONCLUSIONS:

A protocol restricting resuscitation fluid successfully reduced volumes of resuscitation fluid compared with a standard care protocol in adult ICU patients with septic shock. The patient-centred outcomes all pointed towards benefit with fluid restriction, but our trial was not powered to show differences in these exploratory outcomes.

TRIAL REGISTRATION:

NCT02079402.

KEYWORDS:

Critical care; Fluid therapy; Intensive care; Resuscitation; Sepsis; Septic; Shock

Comment in

PMID:
27686349
DOI:
10.1007/s00134-016-4500-7
[Indexed for MEDLINE]

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