EMCrit 428 – A Few Things (ARISE Fluids, Bicarb Studies & More)
The ARISE Fluids trial suggests that continuing aggressive fluid resuscitation beyond initial boluses might not be beneficial for septic shock patients who have already received significant volumes, especially when considering vasopressor use. While the 30 mL/kg rule is widely known, remember this data pertains to a specific subset of heavily resuscitated patients. Be cautious about over-interpreting these fluid guidelines without regard to local institutional protocols.
This briefing summarizes several key trials presented at the Critical Care Reviews 2026 meeting, with a significant focus on fluid resuscitation in septic shock via the ARISE Fluids trial. The discussion addresses the evolving guidelines surrounding aggressive fluid administration, particularly in the context of the established 30 mL/kg mandate. Beyond fluids, the article also reviews recent data regarding sodium bicarbonate use in both cardiac arrest and metabolic acidosis settings, while also correcting common misunderstandings about DKA resolution acid-base management. It's a comprehensive update covering multiple critical care domains.