Lower and higher IV Fluid volumes have equal mortality and adverse events in sepsis patients

Denmark: A new research found that in adult patients with sepsis, the type of fluid volumes do not have any benefit or damage as Lower IV fluid volumes are likely to have barely any effect in all-cause mortality and serious adverse events when compared to higher IV fluid volumes. The study was published in the Chest Journal.

Intravenous (IV) fluids are essential for the management of sepsis, but current guidelines are backed by evidence of extremely low certainty. As there are conflicting results on the effect of lower and higher fluid volumes on patient-reported outcomes of sepsis management, researchers conducted a systematic review with meta-analysis to provide a summary of the available evidence on patient-important outcomes of lower vs higher IV fluid volumes in adult patients with sepsis.

Researchers conducted a systematic review with meta-analysis and trial sequential analysis of randomized clinical trials assessing lower vs higher IV fluid volumes in adult patients with sepsis. The co-primary outcomes were all-cause mortality, serious adverse events (SAEs), and health-related quality of life (HRQoL). The study was carried out following the recommendations by the Cochrane Handbook and using the Grading of Recommendations Assessment, Development, and Evaluation approach (GRADE). Primary conclusions were based on low risk of bias (RoB) trials if available.

Key findings: No significant

• 13 trials were included (n=4006) with four additional trials (n=3385) added to this update.
• The meta-analysis of all-cause mortality in eight low RoB trials showed a relative risk (RR) of 0.99 (97% CI 0.89 to 1.10; moderate certainty evidence).
• Six trials with predefined definitions of SAEs showed a RR of 0.95 (97% CI 0.83 to 1.07; low certainty evidence).
• HRQoL was not reported.

Take-home points:

Lower IV fluid levels in adult patients with sepsis are likely to result in little to no change in all-cause mortality compared to greater IV fluid volumes, but the conclusion is hampered by imprecision in the estimate, which does not rule out either benefit or damage.

Similarly, data show that decreased IV fluid amounts have little to no effect on major adverse outcomes. There were no HRQoL trials reported.

Further reading: Sivapalan P, Ellekjaer KL, Jessen MK, et al. Lower vs Higher Fluid Volumes in Adult Patients with Sepsis - An Updated Systematic Review with Meta-Analysis and Trial Sequential Analysis [published online ahead of print, 2023 May 2]. Chest. 2023;S0012-3692(23)00637-2. doi 10.1016/j.chest.2023.04.036