RecentRCT

ARISE FLUIDS

Vasopressors or Fluids in Early Septic Shock

The New England journal of medicine, 2026 · Multicenter randomized trial

Population: 1,000 randomized; 963 in the consented analysis population with ED septic shock
Intervention: Restricted fluid with earlier vasopressors
Comparator: More fluid with later vasopressors
Primary outcome: Days alive and outside hospital through day 90
Result: Median 76 days in both groups; difference 0.0 (95% CI −2.7 to 2.7), P=1.00. Pulmonary edema was less frequent with the vasopressor strategy.

What the trial found

Median 76 days in both groups; difference 0.0 (95% CI −2.7 to 2.7), P=1.00. Pulmonary edema was less frequent with the vasopressor strategy.

Clinical interpretation

Neither strategy improved the primary outcome. Individualize fluids and vasopressors to perfusion and fluid tolerance; this is not proof that fluid can be universally omitted.

Limitations

Apply only to the source-defined population and outcomes; full protocol/subgroup details were not verified for every report.

Moderate certainty

Clinical Context & Relevant Topics (2)

Disease Reference

Sepsis

Life-threatening organ dysfunction caused by a dysregulated host response to infection — recognized by an acute rise in SOFA score, not by infection plus fever alone.

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Septic Shock

The subset of sepsis with profound circulatory and cellular/metabolic abnormality — clinically identified by a vasopressor requirement to maintain MAP ≥ 65 mmHg plus lactate > 2 mmol/L despite adequate fluid resuscitation.

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