Dear Editor,

We read with great interest the REDUSE trial paper by Linden and colleagues [1] and particularly commend the comprehensive protocol that recognised the importance of nutrition to fluid accumulation [2] and detailed instructions on concentrating drug administration.

However, we are concerned about the external validity of fluid input with the usual care arm of the REDUSE trial. Such patients received a median fluid input of 9.76 L in the first three days of ICU stay.

In 6412 patients with septic shock, from a previously described cohort [3], admitted to 12 participating ICUs in Australia we found a median fluid input over the first 3 days, D0–D3, of 5.99 L. The overall fluid input over the first three days of ICU admission, together with the single-day breakdown is presented in Fig. 1. The median fluid input of under 6 L was the same as the 6.01 L reported in the intervention arm of the REDUSE trial, demonstrating different baseline practices.

(…)

https://ccforum.biomedcentral.com/articles/10.1186/s13054-024-04977-1