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Emergency Medical Minute


Jul 11, 2022

Contributor: Aaron Lessen, MD

Educational Pearls:

  • Septic shock management has traditionally endorsed rapid fluid resuscitation and the administration of vasopressors
  • Current guidelines are for patients to initially receive a 30 ml/kg fluid bolus then additional fluid as needed for continued hypotension
  • The ideal volume of fluid needed to maximize patient outcomes has been debated
  • A recent ICU-based study examined mortality differences between patient receiving restricted vs standard fluid therapy for septic shock
  • There was no significant difference in the rate of mortality or adverse outcomes between the two groups indicating that the amount of fluid used after the initial bolus does not affect patient outcomes
  • More research needed to evaluate the ideal  fluid volumes used in the initial resuscitation of septic shock


Errata: *** “The primary outcome was death within 90 days after randomization”



Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247.

Meyhoff TS, Møller MH, Hjortrup PB, Cronhjort M, Perner A, Wetterslev J. Lower vs higher fluid volumes during initial management of sepsis: a systematic review with meta-analysis and trial sequential analysis. Chest. 2020;157(6):1478-1496.

Meyhoff TS, Hjortrup PB, Wetterslev J, et al. Restriction of Intravenous Fluid in ICU Patients with Septic Shock. N Engl J Med. 2022;386(26):2459-2470.


Summarized by Mark O’Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD


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