- In people with sepsis-induced hypotension, restrictive fluid management did not change all-cause mortality by day 90.
A study conducted at 60 U.S. centers compared two strategies for the management in the first 24 hours of sepsis-induced hypotension in patients already treated with fluids.Compared to liberal fluid management, a restrictive strategy (favoring the use of vasopressor drugs) neither reduced nor increased mortality by day 90.
As the researchers explain in the New England Journal of Medicine, both fluids and vasopressor agents are commonly used for the resuscitation of patients with sepsis, but there is not much data to indicate which one to prefer.
CLOVERS, this is the name of the study, included between 2018 and 2022 over 1,560 adults with hypotension induced by sepsis refractory to the intravenous administration of 1-3 liters of fluids, assigned within 4 hours to a restrictive or a liberal strategy, according to precise protocols, for a period of 24 hours. The restrictive strategy prioritized the use of vasopressors as the primary treatment before resorting to intravenous fluids, while the liberal strategy favored the use of high volumes of fluids before using drugs.
Initially it was assumed that with the restrictive strategy mortality from all causes (by day 90, primary outcome) would be lower than with the liberal one, but the percentage of patients who died was similar between the groups (14% and 14.9% of patients died respectively).The number of serious adverse events was also similar.
For researchers, it is possible that there are subgroups in which the choice of one approach opposite to the other makes a difference, which should be evaluated in future studies.
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Source — https://www.univadis.it/viewarticle/ipotensione-indotta-da-sepsi-una-strategia-vale-2023a10001pf