News: IV fluid restrictions showed no benefit for septic shock, trial finds

Study findings from a recent CLASSIC trial showed that implementing a more restrictive protocol for IV fluids didn’t decrease mortality rates for intensive care unit (ICU) patients receiving septic shock treatment. As reported by Medpage Today, “Restricting IV crystalloid fluids to small boluses only for severe hypoperfusion, to replace documented fluid losses, or for dehydration and electrolyte deficiency for patients who couldn't take fluids enterally, yielded a 42.3% survival rate at ICU discharge or up to 90 days, compared with 42.1% without a restriction on fluids.”

This trial included 1,554 patients in 31 ICUs across Belgium, the United Kingdom, Czech Republic, Italy, Switzerland, Sweden, Norway, and Denmark, and findings showed that serious adverse events, number of days alive, number of days without life support, and days out of the hospital were similar between the two groups examined. The standard group care got a substantially lower IV volume than observed in trials of early, goal-directed resuscitation, while the usual group care in the CLASSIC trial followed guidelines for a 30 mL/kg body weight for their initial IV fluid dose and further fluids as directed without a set upper limit. Both groups could receive 1 liter of fluids to meet daily intake requirements (and as a medium of medication), while the fluid-restricted group could receive a bolus of 250 to 500 mL of isotonic crystalloid IV fluids if under the following conditions:

• Severe hypoperfusion
• Mean arterial pressure below 50 mm Hg
• Mottling beyond edge of the kneecap
• Urinary output of less than 0.1 mL/kg body weight during the first 2 hours

Editorialists of the trial concluded that "the CLASSIC trial generated rigorous, high-quality evidence related to a complex research question with regard to fluids in patients with septic shock. These findings show that a highly restrictive fluid-management strategy is safe and raise important new questions that challenge conventional wisdom regarding the management of shock."

Editor’s Note: To read Medpage Today’s coverage of this study, click here. To read the full CLASSIC study and its findings, click here.