ARISE FLUIDS: restricted fluids with early vasopressors matched liberal fluids, with less pulmonary oedema

Design

Multicentre randomised trial, restricted fluids with early vasopressors vs liberal fluids with later vasopressors

Population

963 emergency department patients with septic shock analysed (1,000 randomised)

Primary outcome

Days alive and out of hospital to day 90

Effect

Median 76 vs 76 days; difference 0.0 (95% CI -2.7 to 2.7); pulmonary oedema 0.6% vs 5.0%

ARISE FLUIDS randomised 1,000 adults presenting to emergency departments with septic shock to restricted fluid volumes with early vasopressors (499) or higher fluid volumes with later vasopressors (501) for 6 to 24 hours. After 37 patients without consent were excluded, 963 were analysed.

In the first 24 hours, the vasopressor group received a median 1,108 mL less fluid (95% CI -1,395 to -850), and 18.9 percentage points more (13.3 to 24.5) received vasopressors. The primary outcome, days alive and out of hospital at day 90, was a median 76 in both groups (difference 0.0 days, 95% CI -2.7 to 2.7; P=1.00).

Adverse events were similar except pulmonary oedema, which occurred in 0.6% with restricted fluids and 5.0% with liberal fluids (P<0.001). The trial did not show a benefit on the primary outcome, so the choice between the two approaches rests on secondary considerations such as oedema, access to infusion pumps and monitoring.

The trial was done in Australia and New Zealand emergency departments, and the findings apply where early vasopressors can be given safely, which includes peripheral administration protocols and monitoring.

• Both resuscitation approaches gave the same days alive and out of hospital at day 90.
• Restricted fluids with early vasopressors cut pulmonary oedema (0.6% vs 5.0%).
• If you use early vasopressors, ensure monitoring and a safe infusion route.
• The trial did not test settings without infusion pumps or close monitoring.
• Continue to follow your local sepsis guideline, which has not changed on this basis.

Why it matters

It removes the pressure to choose one resuscitation philosophy on outcome grounds and puts the focus on harm and feasibility.

Don't overread it

The trial shows no difference in the primary outcome; it does not show that restricting fluids improves survival.

The statistics, in plain English

A difference of 0.0 days with an interval of -2.7 to 2.7 means the trial excluded a difference larger than about 3 days in either direction. This is an equivalence-like result, not a negative one, which allows other factors, such as oedema risk, to guide the choice.

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