Dynamic testing-based versus restrictive-based fluid administration following early fluid resuscitation in septic shock patients: a pilot randomized controlled trial study

Abstract Background Efforts have been targeting early reversal of a hemodynamically unstable patient in septic shock. The classic rationale for fluid resuscitation in septic shock is to restore intravascular volume deficit with resultant augmentation of cardiac output. Latest surviving sepsis campaign guidelines recommended an initial fluid bolus with subsequent fluid administration, guided by dynamic testing. AIM OF WORK We aimed to test if restrictive fluid protocol was comparable to dynamic-based testing for fluid responsiveness protocol. METHODS This was a prospective cohort study, recruiting septic shock patients, conducted in Critical Care Department, Cairo University. All patients were initially resuscitated. Patients were randomized (1:1 ratio) to restrictive group (fluid administration with predetermined rate of 1 ml/kg/hour), and dynamic-based testing group (fluid administration according to dynamic measures, following passive leg raising method). Positive response was considered when cardiac output increased by 10%. Results Our study recruited 80 patients (39 males) with age of 57.3±18.8 years old. It was noted that clinical severity scores were higher in the restrictive group, with no significant difference in 3 hours lactate. Fluid strategy did not affect mortality. Logistic regression showed no significant difference regarding adjusted mortality, between those who showed acceptable fluid response according to dynamic testing and those who received a restrictive protocol (Hazard’s risk 0.913, P 0.903, CI 95% 0.212 – 3.935). Fluid strategy did not affect need for dialysis, nor mechanical ventilation, nor length of ICU stay. CONCLUSION Restrictive fluid strategy, following initial fluid resuscitation was comparable to dynamic testing-based strategy, in terms of mortality, need for ventilation, need for dialysis and ICU length of stay