ArticleIntensive care medicine experimental2026
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.
Article in Intensive care medicine experimental, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
introductionImmediate fluid resuscitation plays a pivotal role in sepsis management. It remains unclear whether a fixed-volume or personalized strategy is more beneficial. Our aim was to compare effectiveness and safety of personalized vs. fixed-volume resuscitation in septic patients in a systematic review and meta-analysis.
methodsWe conducted a systematic literature search on PubMed, EMBASE and CENTRAL on October 30, 2024. The pre-study protocol was registered with PROSPERO (ID: CRD42024601970). Randomized controlled trials investigated septic patients who received fluid therapy in a personalized way during their initial resuscitation and reported the outcomes of our interest. The meta-analysis was performed using META packages in R with a random-effects model. Risk of bias was assessed using RoB2.
resultsThe selection yielded 10 eligible randomized controlled trials (RCTs) with 1,011 patients. Data from 8 RCTs (n = 901) revealed significantly reduced odds of 30-day mortality, (OR: 0.62; 95% CI: 0.42-0.93); however, there was no significant difference in the requirement for renal replacement therapy (OR: 0.77; 95% CI: 0.23-2.55), duration of mechanical ventilation (MD: 0.27; 95% CI: -3.09-3.63), vasopressor therapy (MD: -3.70; 95% CI: -32.88-25.48) and length of hospital (MD: -0.87; 95% CI: -4.97-3.25) or intensive care unit stay (MD: 0.44; 95% CI: -1.90-2.77).
conclusionPersonalized fluid resuscitation, compared with fixed-volume resuscitation, indicated reduced 30-day mortality in septic patients. However, the observed mortality benefit should be interpreted cautiously given the relatively small overall sample size, predominance of small single-center studies, and moderate-to-low certainty of evidence.
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