Liberal fluid therapy vs Conservative Approach in Management of Sepsis

Low to high-quality evidence indicates that liberal fluid therapy might increase mortality among children with sepsis or septic shock in the hospital, according to a systematic review published in Cochrane.

Fluid therapy is regarded as a crucial intervention during the initial treatment of sepsis. It is still not clear whether conservative or liberal fluid therapy can improve clinical outcomes in patients with sepsis and septic shock.

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The researchers performed a systematic review to investigate whether liberal fluid therapy can lead to more beneficial or harmful effects compared to conservative fluid therapy for adults and children with severe sepsis or septic shock.

The researchers extracted the data from CENTRAL, MEDLINE, Embase, intensive and critical care conference abstracts which included three trials involving 3402 children.

Pooled results from two trials (involving 3288 children) showed that liberal fluid therapy may increase the risk of in-hospital death by 38%, and risk of death at four-week follow-up by 39%. This means that for every 34 children receiving fluid therapy, one more in-hospital death will occur in the liberal fluid therapy group than in the conservative fluid therapy group. Similarly, at four-week follow-up, one more death will occur in the liberal fluid therapy group than in the conservative fluid therapy group for every 29 children receiving fluid therapy. One small study reported inconclusive results on risk of in-hospital death.

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One trial (involving 101 children) reported that conservative fluid therapy can shorten ICU stay and the duration of ventilation.

No studies compared liberal versus conservative fluid therapy in adults. It is uncertain whether there are any differences in adverse events between liberal and conservative fluid therapy because the evidence is of low quality.

The authors warrant the need for trials including adults, patients in other settings, and patients with a broader spectrum of pathogens.

Sepsis and septic shock are complications of infection. Patients in the intensive care unit (ICU) are more likely than others to be affected by this condition. Once affected, patients experience organ dysfunction, which in some cases may lead to death.

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https://www.cochrane.org/CD010593/EMERG_different-fluid-therapy-strategies-sepsis-and-septic-shock