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Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients
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Published on: April 18, 2025

Vasopressors or Fluids in Early Septic Shock.

, Sandra L Peake1,2,3, Stephen P J Macdonald1,4,5

  • 1Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

The New England Journal of Medicine
|June 11, 2026
PubMed
Summary
This summary is machine-generated.

Early vasopressor therapy with restricted fluids for septic shock did not improve 90-day survival compared to higher fluid volumes and later vasopressors. Both approaches yielded similar outcomes for days alive and out of hospital.

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Area of Science:

  • Critical Care Medicine
  • Emergency Medicine
  • Clinical Trials

Background:

  • Optimal early resuscitation for septic shock remains debated.
  • Equipoise exists between aggressive fluid resuscitation and early vasopressor use.
  • Minimizing fluid overload harm is a key consideration in septic shock management.

Purpose of the Study:

  • To compare the efficacy of restricted fluid volumes with early vasopressors versus higher fluid volumes with later vasopressors in septic shock patients.
  • To determine the primary outcome of days alive and out of the hospital at 90 days.

Main Methods:

  • Randomized controlled trial involving adult patients with septic shock.
  • Two arms: restricted fluid/early vasopressors vs. higher fluid/later vasopressors for 6-24 hours.
  • Primary outcome: 90-day survival (days alive and out of hospital).

Main Results:

  • 1000 patients randomized; 963 in intention-to-treat analysis.
  • Vasopressor group received significantly less fluid (-1108 ml) in the first 24 hours.
  • No significant difference in median days alive and out of hospital at 90 days (76 days in both groups).
  • Pulmonary edema was significantly lower in the vasopressor group (0.6% vs. 5.0%).

Conclusions:

  • Restricted fluid volume with early vasopressors is not superior to higher fluid volumes with later vasopressors for 90-day survival in septic shock.
  • Both resuscitation strategies resulted in comparable outcomes for days alive and out of hospital.
  • Early vasopressors may reduce the incidence of pulmonary edema in septic shock management.