Active bundle De Resuscitation in Septic shock : A Randomized controlled trial

Aims and objectives: This study aims to investigate the fluid de resuscitation have negative cumulative fluid balance on day 3 and patient centered outcomes

Methodology: All patient satisfying the inclusion criteria will be included in the study after obtaining written informed consent from patients’s relatives. Data collection includes demographic details, comorbidities, primary diagnosis, operative status, SOFA score, APACHE 2 score, baseline vitals ( Heart rate, blood pressure, respiratory rate, spo2) , baseline arterial blood gas ( P/F ratio, lactate ). The decision regarding de resuscitation will be taken by the intensive care physician as per study protocol. Before de resuscitation cumulative fluid balance will be measured at the time randomization.  The patient will be randomized in 1;1 ratio in the following 2 groups, Active de resuscitation group ( fluid restriction, limb elevation with compression bandage application, administering furosemide infusion at rate of 10mg/hour , maximum dose upto 240 mg/day) and standard of care group. All patients included in the study will undergo daily measurement of fluid balance and VExUS score for first 3 days ( day 1,2,3). Target of intervention wil be equibalance of fluid on day 1, negative fluid balance on day 3 and VExUS less than 1. Patient will be excluded from studies if any of the following condition after randomization

1. Hypotension ( Mean arterial pressure less than 65 mmHg)

2. persistent and increasing vasopressor requirement ( Nor adrenaline more than 0.15 mcg/kg/min)

3. secondary infection

4. lactate > 4 mmol/l

5. Hypernatremia ( serum sodium > 155 meq/l)

6. Hypokalemia and metabolic alkalosis