(1466) Lower Versus Higher IV Fluid Volumes in Sepsis: A Meta-Analysis of Randomized Controlled Trials

Introduction: Fluid resuscitation is a cornerstone of sepsis treatment, but the optimal fluid replacement strategy remains uncertain. The utilization of restrictive and liberal intravenous (IV) fluid strategies has been documented in numerous studies with conflicting results. This systematic review and meta-analysis aims to address this uncertainty by evaluating the latest evidence on lower vs. higher volume IV fluids in sepsis management.

Methods: We searched several electronic databases including MEDLINE (via PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov to retrieve randomized controlled trials (RCTs) comparing lower IV fluid volumes with higher IV fluid volumes in patients with sepsis. Our primary outcomes were all-cause mortality and serious adverse events (SAEs). Our secondary outcomes consisted of the ICU length of stay (LOS), vasopressor-free days, ventilation-free days, incidence of acute kidney injury (AKI), and incidence of myocardial infarction (MI). We used RevMan 5.4 to pool risk ratios (RRs) and mean differences (MDs) along with confidence intervals (95% CIs) under a random-effects model.

Results: Our meta-analysis included 11 RCTs involving 3729 patients. There was no significant difference between the lower and higher fluid volume groups regarding all-cause mortality (RR 0.98, 95% CI: 0.89-1.07; I2 =0%; moderate certainty), and SAEs (RR 1.03, 95% CI: 0.72-1.46; I2 =0%; low certainty). There were no significant differences between both groups when assessing the risk of AKI (RR 0.89, 95% CI 0.78-1.02; I2 =0%), vasopressor-free days (MD 0.37 days, 95% CI -1.13 to 1.87 days; I2 =65%), ventilator-free days (MD 0.32 days, 95% CI -0.58 to 1.22; I2 =0%), and the incidence of MI (RR 0.62, 95% CI: 0.13 - 2.92; I2 =68%).

Conclusions: Low to moderate-quality evidence suggests that restrictive and liberal fluid therapies may yield comparable outcomes in patients with sepsis. For definitive conclusions, large-scale, high-quality RCTs need to be conducted.