ReviewJournal of thoracic disease2020
Fluid resuscitation in sepsis: the great 30 mL per kg hoax.
Review in Journal of thoracic disease, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 2 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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
52 citing papers in PubMed, 2 syntheses or guidelines pooled 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
- Early fluid bolus in adults with sepsis in the emergency department: a systematic review, meta-analysis and narrative synthesis.BMC emergency medicine · 2022Pooled it
- Restrictive versus standard intravenous fluid therapy and NTproBNP in ICU patients with septic shock - a sub-study of the randomised CLASSIC trial.BMC anesthesiology · 2026Trial
- 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
- Energy, flow and pressure in the cardiovascular system: a narrative review of how the circulation works.Anaesthesia · 2026Review
- Artificial Intelligence to Facilitate SEP-1 Measure Compliance and Fluid Management in Sepsis.Journal of clinical medicine · 2026Review
- Intelligent Reasoning Cues: A Framework and Case Study of the Roles of AI Information in Complex Decisions.Proceedings of the SIGCHI conference on human factors in computing systems. CHI Conference · 2026Article
- Early inotropic support without fluid bolusWorld journal of clinical pediatrics · 2026Article
- The Physiology, Pathophysiology, and Clinical Implications of Fluid Resuscitation in Critically Ill Patients.Cureus · 2026Review
- Resuscitation Targets, Fluids, and Vasoactives in Septic Shock.Clinics in chest medicine · 2026Review
- Restrictive Versus Liberal Fluid Strategy for Initial Resuscitation in Sepsis and Septic Shock: A Systematic Review and Meta Analysis.Journal of clinical medicine research · 2026Article
- Liberal Versus Restrictive Fluid Therapy in the Early Management of Sepsis and Septic Shock: A Systematic Review.Cureus · 2026Review
- Subphenotyping sepsis based on organ interaction trajectory using a deep temporal graph clustering model: a retrospective cohort study.EClinicalMedicine · 2025Article
- Optimal time and volume of fluid resuscitation in patients with sepsis: a nationwide multicenter cohort study.Scientific reports · 2025Article
- Why Has Biomarker-Guided Fluid Resuscitation for Sepsis Not Been Implemented in Clinical Practice?Critical care explorations · 2025Review
- The Association Between Time to Completion of at Least 30 mL/kg and Hospital Outcomes Among Patients With Septic Shock.Critical care explorations · 2025Article
- Lessons from the similarities and differences in fluid resuscitation between burns and sepsis: a bibliometric analysis.Frontiers in medicine · 2025Review
- Article
- An ovine septic shock model of live bacterial infusion.Intensive care medicine experimental · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Large volume fluid resuscitation is currently viewed as the cornerstone of the treatment of septic shock. The surviving sepsis campaign (SSC) guidelines provide a strong recommendation to rapidly administer a minimum of 30 mL/kg crystalloid solution intravenously in all patients with septic shock and those with elevated blood lactate levels. However, there is no credible evidence to support this recommendation. In fact, recent findings from experimental, observational and randomized clinical trials demonstrate improved outcomes with a more restrictive approach to fluid resuscitation. Accumulating evidence suggests that aggressive fluid resuscitation is harmful. Paradoxically, excess fluid administration may worsen shock. In this review, we critically evaluate the scientific evidence for a weight-based fluid resuscitation approach. Furthermore, the potential mechanisms and consequences of harm associated with fluid resuscitation are discussed. Finally, we recommend an individualized, conservative and physiologic guided approach to fluid resuscitation.
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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.