The optimal approach to IVF administration and timing of vasopressor initiation for patients in septic shock remains uncertain. International sepsis guidelines currently provide a weak recommendation on IVF administration within the first three hours of patients with sepsis-induced hypotension, but do not make any specific recommendations on the timing of vasopressor initiation. The largest and most recent randomized trial to compare a restrictive fluid strategy with early vasopressor initiation to a more liberal fluid strategy with later vasopressor initiation failed to demonstrate a benefit between the groups in terms of mortality. In contrast, smaller, single-center trials have suggested a benefit to earlier vasopressor initiation. In this podcast, we discuss a recently published trial, ARISE-FLUIDS, that evaluated a strategy of restricted fluid with early vasopressor initiation to a strategy with greater fluid administration and later vasopressor use in adult patients with septic shock.
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