Historical collection · First published Jun 11, 2026; added to EM Weekly Oct 27, 2026. This retrospective summary may be superseded by later evidence or guidance.
← All articlesVasopressors or Fluids in Early Septic Shock
Summary
This trial randomized 1,000 adults presenting to EDs with septic shock to restricted fluids with earlier vasopressors or more fluids with later vasopressors. Among 963 patients in the intention-to-treat population, median days alive and out of hospital at day 90 were 76 in both groups.
Why it matters
A universal vasopressor-first strategy did not improve the primary outcome. Fluid tolerance and perfusion response should continue to inform resuscitation rather than assuming one strategy fits every patient.
Study at a glance
- Design
- Randomized trial
- Population
- Adults presenting to emergency departments with septic shock.
- Sample size
- 963
- Intervention
- Restricted fluid volumes and early vasopressor therapy for 6-24 hours.
- Comparator
- Higher fluid volumes and later vasopressor therapy.
- Primary endpoint
- Days alive and out of hospital through day 90.
Main findings
- Primary-outcome difference 0.0 days (95% CI -2.7 to 2.7).
- Vasopressor strategy reduced first-day fluid by a median 1,108 mL.
- Pulmonary edema: 0.6% with the vasopressor strategy versus 5.0% with the fluids strategy.
Limitations
Thirty-seven randomized patients lacked consent for inclusion. Different fluid and vasopressor exposure did not establish equivalence or identify the optimal strategy for individual patients.
Read the primary source
Full text: Abstract available; full text paywalled.
Original sourcePMID: 42274006
Material reviewed: abstract.
Source retrieved Oct 27, 2026. Abstract reviewed; full text unavailable. Complete indexed PubMed abstract reviewed and date cross-checked with publisher. Direct full-text request returned 403; no unauthorized copy used. October 8 print issue is not first-online date.
Corrections & review history
No corrections recorded. Human review: not yet human-reviewed.