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REstricted Fluid REsuscitation in Sepsis-related Hypotension (REFRESH): Comparing a ‘restricted volume’ and ‘standard volume’ approaches to fluid resuscitation in patients with sepsis

Quick facts

Principal investigator:
Dr Stephen Mcdonald
Team members:
Prof Gerben Keijzers, Dr Frances Kinnear, A/Prof Glenn Arendts, Prof Simon Brown, Dr Ioana Vlad, Prof David Taylor, Dr David McCutcheon, Dr Stephen Asha, and Prof Daniel Fatovich
Project commenced:


When patients have a serious infection, it can lead to sepsis, which means the infection can affect vital organs. If the blood pressure is low due to sepsis, traditionally doctors would give intravenous fluids. However, evidence suggests that too much fluid may be harmful. What the best amount of fluid is and when medications that support the blood pressure (also called vasopressors) should start is unknown.

This study showed that a restricted fluid and early vasopressor schedule in emergency department patients with suspected sepsis and hypotension appears practical. A future trial is necessary with high-risk patient recruitment to determine effects on clinical outcomes in this setting.

“REFRESH has made clinicians aware that potential harm may occur from both not enough and too much fluid in patients with sepsis. This study will hopefully avoid knee-jerk decisions in fluid management and lead to studies that will provide insight about optimal timing and volume.”

—Prof Gerben Keijzers

Grants Awarded

Emergency Medicine Foundation

Last updated 19 Aug 2020