Early vasopressors with restricted fluids in septic shock: no difference in days alive and home, but less pulmonary oedema

The edition in brief

ARISE FLUIDS, published in NEJM in June, randomised 1,000 adults presenting to Australian and New Zealand emergency departments with septic shock to restricted fluids with early vasopressors or larger fluid volumes with later vasopressors. The restricted group received about 1.1 litres less fluid in 24 hours. Days alive and out of hospital at 90 days were identical (median 76 in both; difference 0.0, 95% CI −2.7 to 2.7). Pulmonary oedema was less common with the restricted strategy (0.6% vs 5.0%). In a retrospective cohort of 194 patients with pulmonary embolism, emergency physician point-of-care ultrasound identified right ventricular dysfunction with 76.8% sensitivity and 85.9% specificity against cardiologist echocardiography, with moderate agreement (kappa 0.63) and better accuracy in moderate to severe dysfunction. In a Japanese multicentre cohort of 94 caregiver–patient pairs after ICU sepsis, mental health problems in caregivers stayed at about 42–43% from three to twelve months while patients' own symptoms eased, and were associated most strongly with the patient's mental, not physical, recovery.