SEPTIC SHOCK: FLUIDS FIRST — OR VASOPRESSORS EARLIER? For y…

SEPTIC SHOCK: FLUIDS FIRST — OR VASOPRESSORS EARLIER?
For years, early septic shock resuscitation has raised a deceptively simple question

1. How much fluid is enough?

2. And when should vasopressors enter the picture?

A new 2026 NEJM trial — the ARISE FLUIDS trial — puts this question to the test.

Researchers compared two approaches in adults presenting to the ED with septic shock.

The takeaway? It neither vindicates mandatory 30 mL/kg fluid for everyone nor proves early vasopressors improve outcomes for all, and instead supports individualised resuscitation after initial fluid loading.

This pairs with the 2026 Surviving Sepsis Campaign guidelines, which still suggest at least 30 mL/kg crystalloid in the first three hours, but on low-certainty evidence with a note to consider individual patient characteristics.

📖 Read the full study: Vasopressors or Fluids in Early Septic Shock | New England Journal of Medicine