{"PubmedArticle":{"MedlineCitation":{"@attributes":{"Status":"PubMed-not-MEDLINE","Owner":"NLM"},"PMID":{"@attributes":{"Version":"1"},"@text":"41953594"},"DateCompleted":{"Year":"2026","Month":"04","Day":"09"},"DateRevised":{"Year":"2026","Month":"04","Day":"09"},"Article":{"@attributes":{"PubModel":"Electronic-eCollection"},"Journal":{"ISSN":{"@attributes":{"IssnType":"Print"},"@text":"1918-3003"},"JournalIssue":{"@attributes":{"CitedMedium":"Print"},"Volume":"18","Issue":"3","PubDate":{"Year":"2026","Month":"Mar"}},"Title":"Journal of clinical medicine research","ISOAbbreviation":"J Clin Med Res"},"ArticleTitle":"Restrictive Versus Liberal Fluid Strategy for Initial Resuscitation in Sepsis and Septic Shock: A Systematic Review and Meta Analysis.","Pagination":{"StartPage":"177","EndPage":"195","MedlinePgn":"177-195"},"ELocationID":[{"@attributes":{"EIdType":"doi","ValidYN":"Y"},"@text":"10.14740\/jocmr6464"}],"Abstract":{"AbstractText":[{"@attributes":{"Label":"BACKGROUND","NlmCategory":"UNASSIGNED"},"@text":"Intravenous fluid resuscitation is essential in early management of sepsis, but the optimal volume and resuscitation strategy are uncertain. This systematic review and meta-analysis aimed to synthesize the evidence comparing the efficacy and safety of restrictive versus liberal fluid resuscitation strategies in adults with sepsis or septic shock."},{"@attributes":{"Label":"METHODS","NlmCategory":"UNASSIGNED"},"@text":"A systematic search of PubMed, Web of Science (WoS), Scopus, and CENTRAL was conducted from inception to November 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Randomized controlled trials (RCTs) and observational cohort studies comparing protocolized restrictive fluid strategies with liberal or standard care were included. Primary outcomes were all-cause mortality and acute kidney injury (AKI). Random-effects models were used to calculate pooled risk ratios (RRs) and mean differences (MDs), while trial sequential analysis (TSA) assessed the conclusiveness of evidence."},{"@attributes":{"Label":"RESULTS","NlmCategory":"UNASSIGNED"},"@text":"Sixteen reports from 15 unique studies (nine RCTs and six observational studies) involving 5,013 patients were included. In the analysis of RCTs, restrictive fluid therapy resulted in no significant difference in all-cause mortality (RR = 0.99; 95% CI, 0.90-1.08; I<sup>2<\/sup> = 0%); however, observational studies showed a significant mortality reduction (RR = 0.69), suggesting confounding by indication in observational datasets. TSA of the RCT data indicated insufficient evidence for mortality benefit. Restrictive strategies were associated with a lower risk of AKI (RR = 0.89; 95% CI, 0.81-0.99; P = 0.02; I<sup>2<\/sup> = 0%) and a reduced incidence of acute respiratory distress syndrome (ARDS) (RR = 0.69; 95% CI, 0.56-0.85; P &lt; 0.001; I<sup>2<\/sup> = 0%). No significant differences were observed in other ischemic, metabolic, or organ support outcomes. However, restrictive fluid therapy reduced the need for mechanical ventilation, shortened the ventilation duration and vasopressin use, and increased ventilator-free days."},{"@attributes":{"Label":"CONCLUSIONS","NlmCategory":"UNASSIGNED"},"@text":"Restrictive fluid resuscitation does not reduce overall mortality in adults with sepsis or septic shock, but it is associated with lower AKI and ARDS risk and decreased dependence on mechanical ventilation. Evidence regarding mortality is inconclusive, highlighting the need for large-scale trials to validate this finding."}],"CopyrightInformation":"Copyright 2026 Authors."},"AuthorList":{"@attributes":{"CompleteYN":"Y"},"Author":[{"@attributes":{"ValidYN":"Y"},"LastName":"Ali","ForeName":"Ahmed Osman","Initials":"AO","AffiliationInfo":[{"Affiliation":"Department of Critical Care, Dr. Soliman Fakeeh Hospital, Riyadh, Saudi Arabia."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Kordi","ForeName":"Hossam Ahmad Adib","Initials":"HAA","AffiliationInfo":[{"Affiliation":"Emergency Department, Abha International Private Hospital, Abha, Saudi Arabia."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Alhag","ForeName":"Marwa Hussein Said Ahmad","Initials":"MHSA","AffiliationInfo":[{"Affiliation":"Department of Pediatric Emergency, Maternity and Children Hospital, Hail, Saudi Arabia."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Salama","ForeName":"Abdelghafar Mohamed Abdelghafar","Initials":"AMA","AffiliationInfo":[{"Affiliation":"Department of Emergency Medicine, Alghad College for Applied Medical Sciences, Riyadh, Saudi Arabia."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Alqarni","ForeName":"Zahra Gumaid","Initials":"ZG","AffiliationInfo":[{"Affiliation":"Intensive Care Unit, King Fahad Hospital, Madinah, Saudi Arabia."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Dwayat","ForeName":"Abdallah","Initials":"A","AffiliationInfo":[{"Affiliation":"Faculty of Medicine, Al-Quds University, Jerusalem, Palestine."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Mustafa","ForeName":"Alam Eldin Musa","Initials":"AEM","AffiliationInfo":[{"Affiliation":"Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia."},{"Affiliation":"Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Kordofan, El Obeid, Sudan."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Okasha","ForeName":"Abdelhadi","Initials":"A","AffiliationInfo":[{"Affiliation":"Jordan University Hospital, Amman, Jordan."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Abdullah","ForeName":"Shouq","Initials":"S","AffiliationInfo":[{"Affiliation":"Prince Sultan Military College of Health Sciences (PSMCHS), Al Amal, Dhahran, Saudi Arabia."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Alali","ForeName":"Nada Saleem Mohammed","Initials":"NSM","AffiliationInfo":[{"Affiliation":"Manchester Program for Medical Education, Mansoura, Egypt."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Alali","ForeName":"Zainab Saleem Mohammed","Initials":"ZSM","AffiliationInfo":[{"Affiliation":"Manchester Program for Medical Education, Mansoura, Egypt."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Hakami","ForeName":"Manal Sa","Initials":"MS","AffiliationInfo":[{"Affiliation":"Research Science in Nursing and Midwifery, Department of Material and Child Health Nursing, Faculty of Nursing, Al-Baha University, Al-Baha, Saudi Arabia."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Alghammas","ForeName":"Yazan Yousef A","Initials":"YYA","AffiliationInfo":[{"Affiliation":"College of Surgeons in Ireland, Dublin, Ireland."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Ali","ForeName":"Niemat Mohammed Tahir","Initials":"NMT","AffiliationInfo":[{"Affiliation":"Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia."}]},{"@attributes":{"ValidYN":"Y"},"LastName":"Alghannami","ForeName":"Ali","Initials":"A","AffiliationInfo":[{"Affiliation":"Ministry of Health, Riyadh, Riyadh Region, Saudi Arabia."}]}]},"Language":["eng"],"PublicationTypeList":{"PublicationType":[{"@attributes":{"UI":"D016428"},"@text":"Journal Article"}]},"ArticleDate":[{"@attributes":{"DateType":"Electronic"},"Year":"2026","Month":"03","Day":"26"}]},"MedlineJournalInfo":{"Country":"Canada","MedlineTA":"J Clin Med Res","NlmUniqueID":"101538301","ISSNLinking":"1918-3003"},"KeywordList":[{"@attributes":{"Owner":"NOTNLM"},"Keyword":[{"@attributes":{"MajorTopicYN":"N"},"@text":"Acute kidney injury"},{"@attributes":{"MajorTopicYN":"N"},"@text":"Restrictive fluid"},{"@attributes":{"MajorTopicYN":"N"},"@text":"Sepsis"},{"@attributes":{"MajorTopicYN":"N"},"@text":"Trial sequential analysis"}]}],"CoiStatement":"The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper."},"PubmedData":{"History":{"PubMedPubDate":[{"@attributes":{"PubStatus":"received"},"Year":"2025","Month":"12","Day":"6"},{"@attributes":{"PubStatus":"accepted"},"Year":"2026","Month":"2","Day":"26"},{"@attributes":{"PubStatus":"medline"},"Year":"2026","Month":"4","Day":"9","Hour":"6","Minute":"31"},{"@attributes":{"PubStatus":"pubmed"},"Year":"2026","Month":"4","Day":"9","Hour":"6","Minute":"30"},{"@attributes":{"PubStatus":"entrez"},"Year":"2026","Month":"4","Day":"9","Hour":"4","Minute":"44"},{"@attributes":{"PubStatus":"pmc-release"},"Year":"2026","Month":"3","Day":"26"}]},"PublicationStatus":"epublish","ArticleIdList":{"ArticleId":[{"@attributes":{"IdType":"pubmed"},"@text":"41953594"},{"@attributes":{"IdType":"pmc"},"@text":"PMC13053473"},{"@attributes":{"IdType":"doi"},"@text":"10.14740\/jocmr6464"}]},"ReferenceList":[{"Reference":[{"Citation":"Angus DC, van der Poll T. 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