• Praleene Sivapalan, Karen L Ellekjaer, Marie K Jessen, Tine S Meyhoff, Maria Cronhjort, Peter B Hjortrup, Jørn Wetterslev, Anders Granholm, Morten H Møller, and Anders Perner.
• Department of Intensive Care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Collaboration for Research in Intensive Care (CRIC), Copenhagen, Denmark. Electronic address: praleene.sivapalan.01@regionh.dk.
• Chest. 2023 Oct 1; 164 (4): 892912892-912.

BackgroundIV fluids are recommended for adults with sepsis. However, the optimal strategy for IV fluid management in sepsis is unknown, and clinical equipoise exists.Research QuestionDo lower vs higher fluid volumes improve patient-important outcomes in adult patients with sepsis?Study Design And MethodsWe updated 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 coprimary outcomes were all-cause mortality, serious adverse events, and health-related quality of life. We followed the recommendations from the Cochrane Handbook and used the Grading of Recommendations Assessment, Development and Evaluation approach. Primary conclusions were based on trials with low risk of bias if available.ResultsWe included 13 trials (N = 4,006) with four trials (n = 3,385) added to this update. The meta-analysis of all-cause mortality in eight trials with low risk of bias showed a relative risk of 0.99 (97% CI, 0.89-1.10; moderate certainty evidence). Six trials with predefined definitions of serious adverse events showed a relative risk of 0.95 (97% CI, 0.83-1.07; low certainty evidence). Health-related quality of life was not reported.InterpretationAmong adult patients with sepsis, lower IV fluid volumes probably result in little to no difference in all-cause mortality compared with higher IV fluid volumes, but the interpretation is limited by imprecision in the estimate, which does not exclude potential benefit or harm. Similarly, the evidence suggests lower IV fluid volumes result in little to no difference in serious adverse events. No trials reported on health-related quality of life.Trial RegistrationPROSPERO; No.: CRD42022312572; URL: https://www.crd.york.ac.uk/prospero/.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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