Vasopressors or Fluids in Early Septic Shock.
ARISE FLUIDS Investigators, the ANZICS Clinical Trials Group, and the ACEM Clinical Trials Network, Sandra L Peake, Stephen P J Macdonald et al.
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In 30 seconds
This multicenter randomized trial compared restricted-volume intravenous fluids with early vasopressors against higher-volume fluids with later vasopressors in adults presenting to emergency departments with septic shock. Among 963 patients in the intention-to-treat population, the median number of days alive and out of hospital by day 90 was 76 in both groups (difference, 0.0 days; 95% CI, -2.7 to 2.7; P = 1.00). Pulmonary edema was less frequent with restricted fluids and early vasopressors (0.6% vs. 5.0%; P<0.001).
Key findings
- At day 90, median days alive and out of hospital were 76 in each group (difference, 0.0 days; 95% CI, -2.7 to 2.7; P = 1.00).
- The vasopressor group received less intravenous fluid in the first 24 hours (median difference, -1108 ml; 95% CI, -1395 to -850).
- Pulmonary edema occurred in 0.6% of the vasopressor group and 5.0% of the fluids group (P<0.001).
Why it matters
Early septic shock resuscitation involves balancing restoration of perfusion against potential harms from excess fluid. This trial found no improvement in the primary patient-centred outcome with restricted fluids and earlier vasopressors, while pulmonary edema was less frequent with that approach. The results help quantify the trade-offs between these strategies without establishing superiority on days alive and out of hospital.
What to keep in mind
The primary outcome was assessed through day 90; longer-term outcomes are not reported in the abstract.