Restrictive fluid resuscitation versus liberal fluid resuscitation in patients with septic shock: comparison of outcomes

Objective: To compare the prognosis of restrictive fluid resuscitation (RFR) versus liberal fluid resuscitation (LFR) in patients with septic shock. Methods: A retrospective analysis was conducted using clinical data from 82 septic shock patients treated in the Intensive Care Unit of Aviation General Hospital from January 2021 to December 2023. Patients were divided into two groups: the LFR group (n=41) and the RFR group (n=41), based on the resuscitation strategy used. Results: Both groups demonstrated significant reductions in heart rate (HR) and significant increases in mean arterial pressure (MAP) and central venous pressure (CVP) post-treatment (all P < 0.05). After treatment, the ejection fraction (EF) and cardiac index (CI) were significantly higher in the RFR group compared to the LFR group, while levels of troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were significantly lower in the RFR group (all P < 0.05). After treatment, the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores exhibited a marked decrease in both groups, with the RFR group exhibiting greater reductions in both scales compared to the LFR group (both P < 0.05). The incidence of complications was significantly lower in the RFR group than in the LFR group (P < 0.05). Multivariable analysis identified age and fluid resuscitation modality as risk factors for complications in septic shock. Conclusions: In patients with septic shock, RFR, compared to LFR, appears to better maintain hemodynamic stability and reduce myocardial injury. It also enhances cardiac function, mitigates organ failure, and lowers complication rates, possibly facilitating faster recovery.