We often overload our septic shock patients with IV fluids.
The CLASSIC trial looked at the fluids we give in the ICU after resuscitation in the ED.
This is not medical advice. Read the article for yourself.
Almost 1600 patients were enrolled in either the standard or restrictive IV fluid group.
Before arriving to the ICU, these patients received around 3L of fluids.
In the ICU, the restrictive group had to meet certain criteria to get more fluids.
These included a lactate > 4, a MAP < 50 despite vasopressors, a mottling score > 2, or low urine output amongst others.
I really wish they would have used dynamic parameters instead.
There was no difference in death by day 90.
But what really caught my eye was that sepsis mortality was 42% despite getting very good care.
Necrotic digits and gut ischemia was not a problem in either group.
Neither strategy was better than the other regarding renal function.
It doesn’t seem like length of stay was looked at.
I guess we are going to have to look elsewhere to improve sepsis outcomes.
ADDENDUM: The CLOVERS trial has been published. Check out my take on it HERE.
Citation for the CLASSIC Trial
Meyhoff TS, Hjortrup PB, Wetterslev J, Sivapalan P, Laake JH, Cronhjort M, Jakob SM, Cecconi M, Nalos M, Ostermann M, Malbrain M, Pettilä V, Møller MH, Kjær MN, Lange T, Overgaard-Steensen C, Brand BA, Winther-Olesen M, White JO, Quist L, Westergaard B, Jonsson AB, Hjortsø CJS, Meier N, Jensen TS, Engstrøm J, Nebrich L, Andersen-Ranberg NC, Jensen JV, Joseph NA, Poulsen LM, Herløv LS, Sølling CG, Pedersen SK, Knudsen KK, Straarup TS, Vang ML, Bundgaard H, Rasmussen BS, Aagaard SR, Hildebrandt T, Russell L, Bestle MH, Schønemann-Lund M, Brøchner AC, Elvander CF, Hoffmann SKL, Rasmussen ML, Martin YK, Friberg FF, Seter H, Aslam TN, Ådnøy S, Seidel P, Strand K, Johnstad B, Joelsson-Alm E, Christensen J, Ahlstedt C, Pfortmueller CA, Siegemund M, Greco M, Raděj J, Kříž M, Gould DW, Rowan KM, Mouncey PR, Perner A; CLASSIC Trial Group. Restriction of Intravenous Fluid in ICU Patients with Septic Shock. N Engl J Med. 2022 Jun 17. doi: 10.1056/NEJMoa2202707. Epub ahead of print. PMID: 35709019.
Link to Article (NOT FREE)
How to Support My Work
My efforts are at no cost to you and I would like to keep it that way. You have to look at ads on this website, listen to them on my podcast and YouTube content. Thanks for bearing with me. You could also support my work by clicking on my Amazon Affiliate links prior to ordering things off of Amazon.
For example, if you want to learn more about Mechanical Ventilation, I recommend starting off with The Ventilator Book by Will Owens. If you click on that link, a window for Amazon will open up and I will earn between a 1-3% commission at no expense to you. The fun thing is that if you order anything else on Amazon, I will earn that amount off of your shopping cart even if you do not purchase the book. Pretty cool, right? In 2021, Amazon Affiliates helped me pay for the hosting of my website, LLC fees, and Netflix.
Although great care has been taken to ensure that the information in this post is accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.