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FRESH RCT – Fluid Responsiveness Evaluation in Sepsis-associated Hypotension

May 29, 2020

Written by Clay Smith

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Basing IV fluid administration on stroke volume increase with passive leg raise vs. usual care resulted in a lower 72-hour fluid balance and improvement in other important outcomes as well.

Why does this matter?
Excess IV fluid is far from harmless. It causes, “tissue edema, organ dysfunction, increased ICU length of stay, prolonged ventilator dependence, and higher mortality.” Does resuscitation based on dynamic assessment of fluid responsiveness improve outcome?

Got a FRESH new study for you
This was an industry-funded, multicenter, unblinded RCT including ED patients with sepsis-associated hypotension and planned ICU admission; 83 were enrolled in the intervention group and 41 enrolled in the usual care arm. See the FRESH treatment algorithm below. The intervention group had stroke volume change after passive leg raise measured using a noninvasive thoracic electrical current device. Using complex measures of current that vary in systole and diastole, the device can give an accurate, non-invasive way to calculate stroke volume. For the primary outcome, 72-hour fluid balance, the intervention group received significantly less IV fluid than the usual care patients: -1.37L (intervention group, 0.65 ± 2.85L vs. usual care, 2.02 ± 3.44L; p=0.021). Interestingly, nearly all secondary outcomes also appeared to favor the intervention group. Notably, significantly fewer needed renal replacement therapy and mechanical ventilation, and more patients were discharge home vs rehab. This is a promising way to more intelligently give IV fluid in patients with sepsis and hypotension, rather than the one-size-fits-all 30mL/kg approach, and appears to improve outcome for these patients.

From cited article

Fluid Response Evaluation in Sepsis Hypotension and Shock: A Randomized Clinical Trial. Chest. 2020 Apr 27;S0012-3692(20)30768-6. doi: 10.1016/j.chest.2020.04.025. Online ahead of print. DOI: 10.1016/j.chest.2020.04.025

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