SynthesisChest2023
Lower vs Higher Fluid Volumes in Adult Patients With Sepsis: An Updated Systematic Review With Meta-Analysis and Trial Sequential Analysis.
Synthesis in Chest, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 3 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
23 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Research without prior consent procedure and intervention effect on mortality in critical care: a meta-epidemiological study of randomized controlled trials.Critical care (London, England) · 2025Pooled it
- The Effect of Severe Sepsis and Septic Shock Management Bundle (SEP-1) Compliance and Implementation on Mortality Among Patients With Sepsis : A Systematic Review.Annals of internal medicine · 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
- Deresuscitation Informed by Ultrasound in Patients With Septic Shock Trial: A Pilot Randomized Controlled Study.Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine · 2026Trial
- Protocolized reduction of non-resuscitation fluids versus usual care in septic shock patients (REDUSE): a randomized multicentre feasibility trial.Critical care (London, England) · 2024Trial
- [Vasopressors or fluids in early septic shock].Die Anaesthesiologie · 2026Article
- Refined trial sequential analysis for meta-analyses with few studies.Journal of the Royal Statistical Society. Series C, Applied statistics · 2026Article
- Artificial Intelligence to Facilitate SEP-1 Measure Compliance and Fluid Management in Sepsis.Journal of clinical medicine · 2026Review
- Protocolized REDUction of Non-Resuscitation Fluids in SEptic Shock Patients. A Protocol for the REDUSE Randomized Clinical Trial.Acta anaesthesiologica Scandinavica · 2025Article
- Novel therapies and interventions in sepsis and septic shock.BJA education · 2025Review
- The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024.Journal of intensive care · 2025Article
- Physician awareness of fluid volume administered with intravenous antibiotics: a structured interview-based study.Clinical and experimental emergency medicine · 2025Article
- Understanding fluid dynamics and renal perfusion in acute kidney injury management.Journal of clinical monitoring and computing · 2025Review
- Understanding, assessing and treating immune, endothelial and haemostasis dysfunctions in bacterial sepsis.Intensive care medicine · 2024Review
- Fluid boluses and infusions in the early phase of resuscitation from septic shock and sepsis-induced hypotension: a retrospective report and outcome analysis from a tertiary hospital.Annals of intensive care · 2024Article
- Blood pressure response index and clinical outcomes in patients with septic shock: a multicenter cohort study.EBioMedicine · 2024Article
- Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment-a comprehensive review.Annals of intensive care · 2024Review
- Managing sepsis and septic shock in an endothelial glycocalyx-friendly way: from the viewpoint of surviving sepsis campaign guidelines.Annals of intensive care · 2024Review
- Sepsis Management in the Cardiac Intensive Care Unit.Journal of cardiovascular development and disease · 2023Review
- Fluid Resuscitation in Septic Patients.Cureus · 2023Review
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
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 QUESTION: Do 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/.
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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.