How much fluid resuscitation is optimal in septic shock?

Table 1 Relevant cohort studies of high versus low fluid volume in sepsis and septic shock

Study	Clinical condition studied	Randomized, controlled interventions	High fluid group mortality	Low fluid group mortality (Pvalue for high vs. low fluid comparison)
Randomized controlled trials
Rivers and colleagues [2]	Severe sepsis and septic shock	EGDT vs. usual care	30.5%^a (EGDT)	46.5% (usual care; P = 0.009)
Observational cohort studies
Smith and Perner [1]	Septic shock	NA	24%	65%^b (P < 0.001)
Carlsen and Perner [15]	Septic shock	NA	38%	29% (P = 0.36)
McIntyre and colleagues [16]	Septic shock	NA	45%	44%
Vincent and colleagues [11]	Sepsis	NA		Odds ratio 1.1 per liter increase^b
Gao and colleagues [8]	Sepsis	NA	29%	55% (P = 0.045)^c
Jones and colleagues [10]		NA	18%	27% (95% CI = +5% to -21%)^d
Nguyen and colleagues [14]	Sepsis	NA	26%	39%^e

CI, confidence interval; EGDT, early goal-directed therapy; NA, not applicable. ^aStatistically significant in favor of high fluid group compared with low fluid group (that is, high fluid group had lower mortality). ^bStatistically significant in favor of low fluid group compared with high fluid group (that is, low fluid group had lower mortality). ^cComparison of compliant (high fluid group) versus noncompliant to sepsis bundle. ^dMcIntyre and colleagues evaluated first 6 hours of fluids given. ^eCompletion of EGDT within 6 hours (high fluid group) or not.

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