Dextrose 5% versus normal saline as maintenance fluid therapy in patients with septic shock (DEMANDS): a randomized controlled trial

Abstract

Objective To determine the effects of Dextrose 5% for maintenance and creep fluids on cumulative fluid balance (CFB) for septic shock concerning adult people.Design An open-label randomized clinical trial with a single center and parallel groups.Setting ICUs of a tertiary care academic medical center.Patients Adult individuals who have developed septic shock as described by the Sepsis 3 criteria.Interventions Dextrose 5% (n = 50) versus Saline 0.9% (n = 50) for maintenance and creep fluid for 72 hours.Main variables of interest The primary outcome measured was the CFB at 72 hours. Secondary outcomes assessed included mortality within 28 days, the number of days patients were free from (coma and delirium, ICU, mechanical ventilation, vasopressors), the occurrence of acute kidney injury, and disturbances in electrolyte levels.Results The CFB was significantly lower in Dextrose group vs Saline group (4.46 versus 6.75 L, median difference; −2.06 L; 95% CI, −2.63 to −1.35; p = P < 0.001). No significant difference mortality within 28 days (32% in the Dextrose vs 42% in the saline group; hazard ratio, 0.7; 95% CI, 0.36 to 1.34, p = 0.28). The proportions of patients with hyponatremia were higher in the Dextrose than the Saline group (31% versus 0%, p < 0.001).Conclusions Particularly in cases of septic shock, maintenance and creep fluids with Dextrose 5% as compared to Saline 0.9% resulted in a significantly lower CFB at 72 hours.

Keywords

• Septic shock
• intravenous infusions
• hypotonic solutions
• saline solution
• cumulative fluid balance