Andrews B. et al carried out a study to establish if an early resuscitation protocol with intravenous fluids, vasopressors, and blood transfusion infusion affects mortality in patients with sepsis and hypotension contrasting with usual care.

They randomized 212 adults with sepsis (with suspected infection plus ≥2 systemic inflammatory response syndrome criteria) and hypotension (with systolic blood pressure ≤90 mm Hg or mean arterial pressure ≤65 mm Hg), to either 

(1) an early resuscitation protocol for sepsis (n = 107) with intravenous fluid bolus administration and proper monitoring for jugular venous pressure, respiratory rate, and arterial oxygen saturation and administration of vasopressors targeting mean arterial pressure (≥65 mm Hg) and blood transfusion (for patients with a haemoglobin level <7 g/dL) or 

(2) usual care (n = 105) with hemodynamic management.

The primary outcome was the assessment of in-hospital mortality, While the secondary outcome was the assessment of the volume of intravenous fluid received and receipt of vasopressors.

The observations of the study were as follows-

The primary outcome-

in-hospital mortality reported in 48.1% in the sepsis protocol group contrasting 33.0% in the usual care group.

The secondary outcome-

In the 6 hours after hospitalization, patients in the sepsis protocol group received a median of 3.5 L of intravenous fluid contrasting 2.0 L in the usual care group.

14.2% in the sepsis protocol group and 1.9% in the usual care group received vasopressors.

Thus they concluded that in adult patients with sepsis and hypotension a protocol for early resuscitation with the administration of intravenous fluids and vasopressors can increase in-hospital mortality compared with usual care. They also necessitated the need for further studies.

Source: JAMA. 2017 Oct 3;318(13):1233-1240. doi: 10.1001/jama.2017.10913. PMID: 28973227; PMCID: PMC5710318.