ArticleCritical care medicine2019
Evaluation and Predictors of Fluid Resuscitation in Patients With Severe Sepsis and Septic Shock.
Article in Critical care medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07172451 (Efficacy and Safety of Balanced Gelatin Solution for Fluid Infusion in Sepsis Patients Undergoing Emergency Abdominal Surgery), which is not on this map. Cited by 79 papers, 4 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.
Efficacy and Safety of Balanced Gelatin Solution for Fluid Infusion in Sepsis Patients Undergoing Emergency Abdominal Surgery: A Multicenter, Adaptive Designed, Randomized Controlled Trial
Who cites it
79 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- 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
- Early management of adult sepsis and septic shock: Korean clinical practice guidelines.Acute and critical care · 2024Guideline
- Comparative Efficacy of Tonic Chinese Herbal Injections for Treating Sepsis or Septic Shock: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials.Frontiers in pharmacology · 2022Pooled it
- 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
- Comorbidities, Weight-Based Initial Fluid Resuscitation, and Mortality in Patients With Sepsis.JAMA network open · 2026Article
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- Resuscitation Targets, Fluids, and Vasoactives in Septic Shock.Clinics in chest medicine · 2026Review
- The Physiology, Pathophysiology, and Clinical Implications of Fluid Resuscitation in Critically Ill Patients.Cureus · 2026Review
- Point-of-care ultrasound in emergency department sepsis and septic shock: a pragmatic framework for source-oriented assessment and physiologic reassessment.Frontiers in medicine · 2026Review
- Evidence-based fluid resuscitation of the septic HFpEF patient: A narrative review of the literature.Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) · 2026Review
- Hemodynamic Heterogeneity in Community-Acquired Sepsis at Intermediate Care Admission: A Prospective Pilot Study Using Impedance Cardiography.Healthcare (Basel, Switzerland) · 2025Article
- Initial fluid resuscitation in septic shock: Reassessing the 30 mL/kg paradigm.Journal of intensive medicine · 2025Article
- Optimal time and volume of fluid resuscitation in patients with sepsis: a nationwide multicenter cohort study.Scientific reports · 2025Article
- Effects of Acute Abdomen III on Sepsis-Induced Intestinal Damage in a Rat Model.Journal of microbiology and biotechnology · 2025Article
- Why Has Biomarker-Guided Fluid Resuscitation for Sepsis Not Been Implemented in Clinical Practice?Critical care explorations · 2025Review
- Fluid management strategies in critically ill patients with ARDS: a narrative review.European journal of medical research · 2025Review
- Evaluating Sepsis Management and Patient Outcomes: A Comprehensive Retrospective Study of Clinical and Treatment Data.Journal of clinical medicine · 2025Article
- Article
- The Association Between Time to Completion of at Least 30 mL/kg and Hospital Outcomes Among Patients With Septic Shock.Critical care explorations · 2025Article
19 more citing papers are in PubMed but not listed here.
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Authors and funding
9 authors.
Funding
Abstract
objectivesRapid fluid resuscitation has become standard in sepsis care, despite "low-quality" evidence and absence of guidelines for populations "at risk" for volume overload. Our objectives include as follows: 1) identify predictors of reaching a 30 mL/kg crystalloid bolus within 3 hours of sepsis onset (30by3); 2) assess the impact of 30by3 and fluid dosing on clinical outcomes; 3) examine differences in perceived "at-risk" volume-sensitive populations, including end-stage renal disease, heart failure, obesity, advanced age, or with documentation of volume "overload" by bedside examination.
designRetrospective cohort study. All outcome analyses controlled for sex, end-stage renal disease, heart failure, sepsis severity (severe sepsis vs septic shock), obesity, Mortality in Emergency Department Sepsis score, and time to antibiotics.
settingUrban, tertiary care center between January 1, 2014, and May 31, 2017. PATIENTS: Emergency Department treated adults (age ≥18 yr; n = 1,032) with severe sepsis or septic shock.
interventionsAdministration of IV fluids by bolus. MEASUREMENTS AND MAIN
resultsIn total, 509 patients received 30by3 (49.3%). Overall mortality was 17.1% (n = 176), with 20.4% mortality in the shock group. Patients who were elderly (odds ratio, 0.62; 95% CI, 0.46-0.83), male (odds ratio, 0.66; CI, 0.49-0.87), obese (odds ratio, 0.18; CI, 0.13-0.25), or with end-stage renal disease (odds ratio, 0.23; CI, 0.13-0.40), heart failure (odds ratio, 0.42; CI, 0.29-0.60), or documented volume "overload" (odds ratio, 0.30; CI, 0.20-0.45) were less likely to achieve 30by3. Failure to meet 30by3 had increased odds of mortality (odds ratio, 1.52; CI, 1.03-2.24), delayed hypotension (odds ratio, 1.42; CI, 1.02-1.99), and increased ICU stay (~2 d) (β = 2.0; CI, 0.5-3.6), without differential effects for "at-risk" groups. Higher fluid volumes administered by 3 hours correlated with decreased mortality, with a plateau effect between 35 and 45 mL/kg (p < 0.05).
conclusionsFailure to reach 30by3 was associated with increased odds of in-hospital mortality, irrespective of comorbidities. Predictors of inadequate resuscitation can be identified, potentially leading to interventions to improve survival. These findings are retrospective and require future validation.
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