Trial reportIntensive care medicine2024
Effects of restrictive fluid therapy on the time to resolution of hyperlactatemia in ICU patients with septic shock. A secondary post hoc analysis of the CLASSIC randomized trial.
Trial report in Intensive care medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 16 citations in OpenAlex.
- 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
- Impact on fluid balance of an optimized restrictive strategy targeting non-resuscitative fluids in intensive care patients with septic shock: a single-blind, multicenter, randomized, controlled, pilot study.Critical care (London, England) · 2024Trial
- Respiratory viral sepsis: rethinking fluid resuscitation and antibiotic stewardship.Science China. Life sciences · 2026Article
- The fluid paradox: dissociation between clinical and ultrasound parameters of fluid overload - results of the INCIVEX exploratory study.Anaesthesiology intensive therapy · 2026Observational
- Survival outcomes, determinants, and hemodynamic trajectories with intravenous βFrontiers in pharmacology · 2026Article
- Personalised fluid therapy in septic shock.Annals of intensive care · 2026Review
- Biomarker-driven risk stratification and early intervention in acute kidney injury: a comprehensive review from early warning to clinical response.Frontiers in medicine · 2026Review
- Lactate dynamics as a marker of perfusion: physiological interpretation and pitfalls.Intensive care medicine · 2025Article
- Use of COAnnals of intensive care · 2025Review
- Lactate Clearance of the Adsorber CytosorbBiomedicines · 2025Article
- Biomarkers in cardiogenic shock: old pals, new friends.Annals of intensive care · 2024Review
- Lactate levels in sepsis: don't forget the mitochondria.Intensive care medicine · 2024Article
- Serial lactate measurements to guide resuscitation: more evidence not to?Intensive care medicine · 2024Article
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Authors and funding
14 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe aim of this study was to examine the effects of intravenous (IV) fluid restriction on time to resolution of hyperlactatemia in septic shock. Hyperlactatemia in sepsis is associated with worse outcome. Sepsis guidelines suggest targeting lactate clearance to guide fluid therapy despite the complexity of hyperlactatemia and the potential harm of fluid overload.
methodsWe conducted a post hoc analysis of serial plasma lactate concentrations in a sub-cohort of 777 patients from the international multicenter clinical CLASSIC trial (restriction of intravenous fluids in intensive care unit (ICU) patients with septic shock). Adult ICU patients with septic shock had been randomized to restrictive (n = 385) or standard (n = 392) intravenous fluid therapy. The primary outcome, time to resolution of hyperlactatemia, was analyzed with a competing-risks regression model. Death and discharge were competing outcomes, and administrative censoring was imposed 72 h after randomization if hyperlactatemia persisted. The regression analysis was adjusted for the same stratification variables and covariates as in the original CLASSIC trial analysis.
resultsThe hazard ratios (HRs) for the cumulative probability of resolution of hyperlactatemia, in the restrictive vs the standard group, in the unadjusted analysis, with time split, were 0.94 (confidence interval (CI) 0.78-1.14) at day 1 and 1.21 (0.89-1.65) at day 2-3. The adjusted analyses were consistent with the unadjusted results.
conclusionIn this post hoc retrospective analysis of a multicenter randomized controlled trial (RCT), a restrictive intravenous fluid strategy did not seem to affect the time to resolution of hyperlactatemia in adult ICU patients with septic shock.
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