The Study: The CLOVERS Trial
Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med 2023;388:499-510
Management of shock is changing and we are moving towards earlier use of vasopressors. The use of fluids and the volume of fluids that we should be using is uncertain. Liberal use of fluids has until now been the mainstay of treatment. New studies have challenged this approach, however the quality of studies has not been robust.
The Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis (CLOVERS) trial compared restrictive fluid therapy with early vasopressor use to liberal fluid therapy. The hypothesis in this paper is that a restrictive fluid strategy used in the first 24 hours, for sepsis-induced hypotension, would lead to lower mortality.
What They Did
This was multicenter, randomized, unblinded superiority trial…..
What They Found
In patients with sepsis-induced hypotension, refractory to initial treatment with 1 to 3 liters of IV fluid, restrictive fluid strategy (and earlier vasopressor use) did not result in significantly different mortality before discharge home by day 90, than a liberal fluid strategy.
Read the whole review first published on www.EMMASTERY.org PLUS watch the video
