Conservative fluid therapy in septic shock: an example of targeted therapeutic minimization

Catherine Chen, Marin H Kollef, Catherine Chen, Marin H Kollef

Abstract

Intravenous fluids (IVFs) represent a basic therapeutic intervention utilized in septic shock. Unfortunately, the optimal method for administering IVFs to maximize patient outcomes is unknown. A meta-analysis of four randomized trials of goal-directed therapy did not demonstrate a significant reduction in mortality (odds ratio 0.609; 95% confidence interval 0.363 to 1.020; P = 0.059), whereas 18 trials with historical controls showed a significant increase in survival (odds ratio 0.580; 95% confidence interval 0.501 to 0.672; P < 0.0001). Based on these data, clinicians should be aware of the potential for harm due to the excessive administration of IVFs to patients with septic shock.

Figures

Figure 1
Figure 1
Summary of evidence search and selection.
Figure 2
Figure 2
Effect of bundled goal-directed therapy (GDT) on the odds ratio of survival (95%confidence interval (CI)) for the four randomized trials analyzed (odds ratio 0.609; 95%CI 0.363 to 1.020;P = 0.059;I2 = 80%,P = 0.002). Rivers et al. 2001 [2]; Lin et al. 2006 [23]; Zhejiang province 2010 [22]; ProCESS 2014 [24].
Figure 3
Figure 3
Effect of bundled goal-directed therapy (GDT) on the odds ratio of survival (95%confidence interval (CI)) for the 18 observational trials analyzed. All 18 studies: odds ratio, 0.580; 95% CI 0.501 to 0.672; P < 0.0001 (I2 = 32%, P = 0.091). With the Ferrer study [33] removed: odds ratio 0.561; 95% CI 0.499 to 0.631; P < 0.0001 (I2 = 0%, P = 0.796).
Figure 4
Figure 4
Effect of bundled goal-directed therapy (GDT) on the standardized paired difference (Std diff) of the means for intravenous fluid use based on study defined resuscitation goals (I2 = 90%,P < 0.001). CI, confidence interval.

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