Historical sample · This article is not presented as new evidence this week.
Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension
Summary
CLOVERS randomized 1,563 adults after initial fluid resuscitation to a restrictive strategy prioritizing vasopressors or a liberal fluid strategy. Death before discharge home by day 90 occurred in 14.0% versus 14.9% (difference -0.9 percentage points; 95% CI -4.4 to 2.6; P=0.61).
Why it matters
The trial did not demonstrate a mortality advantage for either strategy after initial fluids; it does not resolve management before resuscitation.
Study at a glance
- Design
- Randomized trial
- Population
- Adults with sepsis-induced hypotension after 1-3 L of IV fluid, across 60 US centers.
- Sample size
- 1563
- Intervention
- Restrictive fluids with earlier vasopressors over 24 hours
- Comparator
- Liberal fluids before vasopressors over 24 hours
- Primary endpoint
- Death before discharge home by day 90
Main findings
- Primary outcome: 109/782 (14.0%) vs 116/781 (14.9%).
Limitations
Unblinded and stopped for futility. Patients had already received 1-3 L; results do not establish equivalence or apply to all shock states.
Read the primary source
Full text: Open-access full text available.
Original sourcePMID: 36688507
Source retrieved Oct 26, 2026. Abstract reviewed; open-access full text linked for further appraisal.
Corrections & review history
No corrections recorded. Human review: not yet human-reviewed.