About REDUSE

Background

Septic shock is a severe form of sepsis affecting circulation. Approximately 3000 patients are admitted annually to Swedish intensive care units (ICUs) with septic shock, and 45% of them succumb within 90 days. As part of the treatment, large amounts of fluids are administered, both to stabilize circulation (resuscitation fluids) and to dissolve medications and meet daily fluid and nutritional needs (collectively referred to as non-resuscitation fluids). While fluid therapy saves lives, excessive fluid intake also has side effects that can worsen survival. We have recently demonstrated that more restrictive administration of non-resuscitation fluids can reduce total fluid administration by approximately 4 liters during the first 3 days in the ICU.

Objective

Primarily, to evaluate whether restrictive administration of non-resuscitation fluids in septic shock can decrease mortality at 90 days. Additionally, we will study the impact on the degree of respiratory failure during the first 90 days, as well as quality of life and cognitive function after 180 days.

Work plan

Adult patients with septic shock admitted to the ICU will be eligible for national and international inclusion. In Sweden, at least 8 hospitals in 6 regions will participate. Research subjects will be randomly assigned to receive either standard fluid therapy or a minimized amount of non-resuscitation fluids. In total, we plan to include 1850 patients.

Significance

This study is the first to evaluate this aspect of fluid therapy, and it is sufficiently large to confidently identify a relevant effect on mortality, cognitive function, and quality of life in septic shock. Globally, approximately 11 million people are estimated to die from sepsis annually, and any improvement in the treatment of these patients is of great value.