SODa-BIC

In this multicenter open-label RCT across 51 sites in Australia, New Zealand, and Canada, adults presenting to the ED with septic shock (SBP <90 or MAP <65 despite ≥1000 ml IV fluid, lactate >2 mmol/L, on antimicrobials) were randomized to restricted fluids + early vasopressors vs. liberal fluids + later vasopressors for 6–24 hours. Median days alive and out of hospital at day 90 was identical (76 days, IQR 55–83 vs. 55–82; difference 0.0 days, 95% CI −2.7 to 2.7; p=1.00). 90-day mortality was similar (16.4% vs. 14.4%; RR 1.14, 95% CI 0.85–1.54). Pulmonary edema was significantly less frequent with vasopressors (0.6% vs. 5.0%; RR 0.12, p<0.001). RCT, n=963 ITT.