Trial reportIntensive care medicine2016
Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial.
Trial report in Intensive care medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 177 papers, 18 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Conservative vs. Liberal Approach to Fluid Therapy of Septic Shock in Intensive Care (CLASSIC) - a Randomised Clinical Trial
The Conservative vs. Liberal Approach to Fluid Therapy of Septic Shock in Intensive Care Trial
Who cites it
177 citing papers in PubMed, 18 syntheses or guidelines pooled it, 392 citations in OpenAlex.
- Prevalence and representation of comorbidities and multimorbidity in randomised controlled trials in sepsis or septic shock: a systematic review.Critical care (London, England) · 2026Pooled it
- Is restriction of intravenous fluid beneficial for septic shock in ICU patients? A meta-analysis of randomized controlled trials.BMC anesthesiology · 2025Pooled it
- Sex and gender considerations in randomized controlled trials in critical care nephrology: a meta-epidemiologic study.BMC medicine · 2025Pooled it
- The association between integrating echocardiography use in the management of septic shock patients and outcomes in the intensive care unit: a systematic review and meta-analysis.Journal of ultrasound · 2025Pooled it
- European Society of Intensive Care Medicine (ESICM) 2025 clinical practice guideline on fluid therapy in adult critically ill patients: part 2-the volume of resuscitation fluids.Intensive care medicine · 2025Guideline
- Effect of restrictive fluid resuscitation on severe acute kidney injury in septic shock: a systematic review and meta-analysis.BMJ open · 2025Pooled it
- APASL clinical practice guidelines on the management of acute kidney injury in acute-on-chronic liver failure.Hepatology international · 2024Guideline
- Major Publications in the Critical Care Pharmacotherapy Literature: 2022.Critical care explorations · 2023Pooled it
- Pooled it
- Restrictive resuscitation in patients with sepsis and mortality: A systematic review and meta-analysis with trial sequential analysis.Pharmacotherapy · 2023Pooled it
- Fluid challenge in critically ill patients receiving haemodynamic monitoring: a systematic review and comparison of two decades.Critical care (London, England) · 2022Pooled it
- Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: A systematic review and meta-analysis of randomized controlled trials.Cardiology journal · 2022Pooled it
- [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020Guideline
- Assessing Fluid Resuscitation in Adults with Sepsis Who Are Not Mechanically Ventilated: a Systematic Review of Diagnostic Test Accuracy Studies.Journal of general internal medicine · 2019Pooled it
- Liberal Versus Restrictive Intravenous Fluid Therapy for Early Septic Shock: Rationale for a Randomized Trial.Annals of emergency medicine · 2018Pooled it
- Unexplained mortality differences between septic shock trials: a systematic analysis of population characteristics and control-group mortality rates.Intensive care medicine · 2018Pooled it
- Association Between Fluid Balance and Outcomes in Critically Ill Children: A Systematic Review and Meta-analysis.JAMA pediatrics · 2018Pooled it
- Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017 : Expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine.Intensive care medicine · 2017Pooled it
- The Effects of Conservative Fluid Management and Active Deresuscitation on Markers of Tissue Perfusion, Kidney Injury, and Vascular Injury in Critically Ill Adults: A Secondary Analysis of the Role of Active Deresuscitation After Resuscitation-2 (RADAR-2) Trial.Critical care explorations · 2026Trial
- Restricted versus Usual/Liberal Maintenance Fluid Strategy in Mechanically Ventilated Children: An Open-Label Randomized Trial (ReLiSCh Trial).Indian journal of pediatrics · 2025Trial
117 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
Authors and funding
16 authors at 7 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeWe assessed the effects of a protocol restricting resuscitation fluid vs. a standard care protocol after initial resuscitation in intensive care unit (ICU) patients with septic shock.
methodsWe randomised 151 adult patients with septic shock who had received initial fluid resuscitation in nine Scandinavian ICUs. In the fluid restriction group fluid boluses were permitted only if signs of severe hypoperfusion occurred, while in the standard care group fluid boluses were permitted as long as circulation continued to improve.
resultsThe co-primary outcome measures, resuscitation fluid volumes at day 5 and during ICU stay, were lower in the fluid restriction group than in the standard care group [mean differences -1.2 L (95 % confidence interval -2.0 to -0.4); p < 0.001 and -1.4 L (-2.4 to -0.4) respectively; p < 0.001]. Neither total fluid inputs and balances nor serious adverse reactions differed statistically significantly between the groups. Major protocol violations occurred in 27/75 patients in the fluid restriction group. Ischaemic events occurred in 3/75 in the fluid restriction group vs. 9/76 in the standard care group (odds ratio 0.32; 0.08-1.27; p = 0.11), worsening of acute kidney injury in 27/73 vs. 39/72 (0.46; 0.23-0.92; p = 0.03), and death by 90 days in 25/75 vs. 31/76 (0.71; 0.36-1.40; p = 0.32).
conclusionsA protocol restricting resuscitation fluid successfully reduced volumes of resuscitation fluid compared with a standard care protocol in adult ICU patients with septic shock. The patient-centred outcomes all pointed towards benefit with fluid restriction, but our trial was not powered to show differences in these exploratory outcomes.
trial registrationNCT02079402.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.