• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Chronic Disease

Early restrictive fluid management does not reduce mortality in sepsis-induced hypotension

byGrace YinandKiera Liblik
February 17, 2023
in Chronic Disease, Emergency
Reading Time: 2 mins read
0
Share on FacebookShare on Twitter

1. Early use of vasopressors combined with a conservative fluid resuscitation did not result in a mortality benefit over a liberal fluid resuscitation strategy. 

2. Early use of vasopressors combined with conservative fluid resuscitation also did not result in significantly different adverse event outcomes compared to liberal fluid resuscitation. 

Evidence Rating Level: 1 (Excellent)

Study Rundown: Sepsis-induced hypotension often requires admission to the intensive care unit due to hemodynamic instability. Extravasation of intravascular volume into the third space often results in drops in blood pressure, as seen in sepsis-induced hypotension. Fluid resuscitation and the use of vasopressors have been pillars in its management, with the primary goal of maintaining adequate intravascular volume to provide effective circulation. For many patients, both strategies are employed. However, it is unclear whether the approach of initiating vasopressors earlier in the course with a conservative strategy of fluid resuscitation will lead to better mortality benefits when compared with the alternative of being liberal with fluid resuscitation prior to initiating vasopressors later in the course. This study compared these two approaches among adults presenting with sepsis-induced hypotension. The primary outcome of interest was whether one approach yielded a greater mortality benefit at 90-days after the initial event. Results of the study found that there was no difference in 90-day mortality outcome or secondary outcomes of interest between the two modalities. This study was limited in that it excluded patients with extreme volume contraction and those who received more than 3L of fluids in the prehospital setting. Therefore, the results of the study have limited generalizability.

Click to read the study in NEJM

In-Depth [randomized controlled trial]: This study was a multicenter, randomized controlled trial comparing the mortality benefit of two different approaches to managing sepsis-induced hypotension: i) early vasopressor use and conservative fluid management, and ii) liberal fluid resuscitation prior to initiating vasopressor use. All adults with septic-induced hypotension were eligible for the study. Participants with confounding features to the study question were excluded. Those who were screened more than four hours after meeting the criteria for refractory hypotension or more than 24 hours since the first presentation, those who received more than 3L of IV fluids, those who were volume overloaded, and those who were significantly volume contracted from non-sepsis causes. After applying the inclusion and exclusion criteria, 1,563 participants were assigned randomly in a 1:1 ratio to one of the two strategies. The primary outcome was all-cause mortality before discharge at 90 days after the inciting event. Secondary outcomes of interest focused on adverse effects, which included duration of time without ventilator use, renal-replacement therapy, vasopressor use, and discharge from the intensive care unit. Results of the study found that at 90 days, there was no significant difference in all-cause mortality between the two groups (estimated difference, -0.9%; 95% Confidence Interval [CI], -4.4 to 2.6; p=0.61). The secondary analysis found similar results of non-superiority between one strategy over another. In summary, this study suggests that there is no difference between the two approaches to sepsis-induced hypotension.

Image: PD

RELATED REPORTS

72- and 36-hour fever prevention post-cardiac arrest equivalent in preventing mortality

Over-the-scope clips superior to standard treatment of nonvariceal upper GI bleeding

Pegylated interferon lambda reduces the risk of COVID-19-related hospitalization

©2023 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Tags: emergencyFluid managementhypotensionintravenous fluidsresuscitationresuscitation strategiessepsissepsis-induced hypotensionvasopressor
Previous Post

Pegylated interferon lambda reduces the risk of COVID-19-related hospitalization

Next Post

NT-proBNP associated with risk for incident heart failure and all-cause mortality

RelatedReports

Cardiac mortality paradoxically lower during times of national cardiology conferences
Cardiology

72- and 36-hour fever prevention post-cardiac arrest equivalent in preventing mortality

March 24, 2023
Gastric bypass surgery reduces cardio-metabolic risk factors
Emergency

Over-the-scope clips superior to standard treatment of nonvariceal upper GI bleeding

March 22, 2023
Palliative chemotherapy associated with more ICU treatment at end-of-life
Emergency

Pegylated interferon lambda reduces the risk of COVID-19-related hospitalization

February 17, 2023
Antiarrhythmic drugs have no survival benefit in shock-refractory out-of-hospital cardiac arrest
Cardiology

Extracorporeal CPR and conventional CPR similarly improve cardiac arrest survival

February 2, 2023
Next Post
Quick Take: Association of African Ancestry with Electrocardiographic Voltage and Concentric Left Ventricular Hypertrophy: The Dallas Heart Study

NT-proBNP associated with risk for incident heart failure and all-cause mortality

Implementation of pneumococcal vaccine programs linked to decreased antibiotic prescription

2 Minute Medicine Rewind February 20, 2023

Preterm birth associated with lower high school academic performance

One third of university students access mental health services

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Stroke may be associated with sleep disturbances in adults
  • Transcarotid artery revascularization not associated with a significant difference in 30-day risk of stroke, death and myocardial infarction compared to carotid endarterectomy
  • Drinking characteristics in adolescence predict alcohol behaviors in early adulthood
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

Want more physician-written
medical news?

Join over 10 million yearly readers and numerous companies. For healthcare professionals
and the public.

Subscribe for free today!

Subscription options