ReviewAnnals of intensive care2018
Principles of fluid management and stewardship in septic shock: it is time to consider the four D's and the four phases of fluid therapy.
Review in Annals of intensive care, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 269 papers, 9 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.
Association of Respiratory Variation of Superior Vena Cava in Transthoracic View and Fluid Responsiveness in Critically Ill Patients
Platform Adaptive Embedded Trial for Acute Respiratory Distress Syndrome
Intrarenal Venous Flow Change During Fluid Removal in Critically Ill Patients: A Prospective Exploratory Study
Hemodynamic Resuscitation Guided by Non-Invasive Mean Systemic Filling Pressure to Prevent Acute Kidney Injury in Septic Shock: A Randomized Controlled Trial Integrating Renal Doppler Indices
Who cites it
269 citing papers in PubMed, 9 syntheses or guidelines pooled it, 586 citations in OpenAlex.
- Mortality effect of albumin fluid resuscitation in adults with septic shock: a systematic review and dual frequentist-bayesian meta-analysis of randomised trials.Critical care (London, England) · 2026Pooled it
- COSMIC: a core outcome set for intravenous maintenance fluid therapy trials in children.World journal of pediatrics : WJP · 2026Pooled it
- Utilization of left ventricular outflow tract velocity time integral in the assessment of fluid responsiveness in adult patients with sepsis or septic shock - a systematic review.Journal of ultrasound · 2025Pooled it
- Fluid balance and mortality in adult ICU patients with sepsis or septic shock: a systematic review and meta-analysis of observational studies.BMC anesthesiology · 2025Pooled it
- Is restriction of intravenous fluid beneficial for septic shock in ICU patients? A meta-analysis of randomized controlled trials.BMC anesthesiology · 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
- Pooled it
- European Society of Intensive Care Medicine clinical practice guideline on fluid therapy in adult critically ill patients. Part 1: the choice of resuscitation fluids.Intensive care medicine · 2024Guideline
- Study based on bibliometric analysis: potential research trends in fluid management for sepsis.Frontiers in medicine · 2024Pooled it
- Impact of protocolized restrictive versus liberal/usual maintenance fluid strategy on fluid overload among mechanically ventilated children: an open-label randomized trial (ReLiSCh-II trial).European journal of pediatrics · 2026Trial
- Impact of renal vein doppler ultrasound-guided CVP titration in sepsis: a pilot randomized controlled trial.Critical care (London, England) · 2026Trial
- Restrictive fluid management with early de-escalation versus usual care in critically ill patients (reduce trial): a feasibility randomized controlled trial.Critical care (London, England) · 2025Trial
- Sublingual microcirculatory assessment on admission independently predicts the outcome of old intensive care patients suffering from shock.Scientific reports · 2024Trial
- Fluid management for sepsis-induced hypotension in patients with advanced chronic kidney disease: a secondary analysis of the CLOVERS trial.Critical care (London, England) · 2024Trial
- Optimizing Fluid Management Guided by Volumetric Parameters in Patients with Sepsis and ARDS.International journal of molecular sciences · 2023Trial
- The increase in cardiac output induced by a decrease in positive end-expiratory pressure reliably detects volume responsiveness: the PEEP-test study.Critical care (London, England) · 2023Trial
- Restrictive fluids versus standard care in adults with sepsis in the emergency department (REFACED): A multicenter, randomized feasibility trial.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2022Trial
- Comparison of 5% human albumin and normal saline for fluid resuscitation in sepsis induced hypotension among patients with cirrhosis (FRISC study): a randomized controlled trial.Hepatology international · 2021Trial
- Two-dimensional shear wave elastography-based assessment of liver stiffness in critically ill patients with septic shock: a prospective observational study.Internal and emergency medicine · 2026Article
- Personalized fluid resuscitation may reduce mortality in septic shock as compared with fixed-volume approach - a systematic review and meta-analysis of randomized controlled trials.Intensive care medicine experimental · 2026Article
209 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 7 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition. In this paradigm-shifting review, we discuss different fluid management strategies including early adequate goal-directed fluid management, late conservative fluid management and late goal-directed fluid removal. In addition, we expand on the concept of the "four D's" of fluid therapy, namely drug, dosing, duration and de-escalation. During the treatment of patients with septic shock, four phases of fluid therapy should be considered in order to provide answers to four basic questions. These four phases are the resuscitation phase, the optimization phase, the stabilization phase and the evacuation phase. The four questions are "When to start intravenous fluids?", "When to stop intravenous fluids?", "When to start de-resuscitation or active fluid removal?" and finally "When to stop de-resuscitation?" In analogy to the way we handle antibiotics in critically ill patients, it is time for fluid stewardship.
Indexed as
Identifiers
What OpenQuestion holds
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.