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Evidence-based fluid resuscitation of the septic HFpEF patient: A narrative review of the literature Cover

Evidence-based fluid resuscitation of the septic HFpEF patient: A narrative review of the literature

Open Access
|Jan 2026

References

  1. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181–1247. doi:10.1007/s00134-021-06506-y
  2. ProCESS Investigators, Yealy DM, Kellum JA, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014;370(18):1683–1693. doi:10.1056/NEJMoa1401602
  3. Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372(14):1301–1311. doi:10.1056/NEJMoa1500896
  4. ARISE Investigators; ANZICS Clinical Trials Group, Peake SL, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014;371(16):1496–1506. doi:10.1056/NEJMoa1404380
  5. Franco Palacios CR, Thompson AM, Gorostiaga F. A past medical history of heart failure is associated with less fluid therapy in septic patients. Rev Bras Ter Intensiva. 2019 Oct 14;31(3):340–346. doi: 10.5935/0103-507X.20190049. PMID: 31618353; PMCID: PMC7005955.
  6. Powell RE, Kennedy JN, Senussi MH, Barbash IJ, Seymour CW. Association Between Preexisting Heart Failure With Reduced Ejection Fraction and Fluid Administration Among Patients With Sepsis. JAMA Netw Open. 2022 Oct 3;5(10):e2235331. doi: 10.1001/jamanetworkopen.2022.35331. PMID: 36205995; PMCID: PMC9547322.
  7. Acharya R, Patel A, Schultz E, Bourgeois M, Kandinata N, Paswan R, Kafle S, Sedhai YR, Younus U. Fluid resuscitation and outcomes in heart failure patients with severe sepsis or septic shock: A retrospective case-control study. PLoS One. 2021 Aug 19;16(8):e0256368. Doi: 10.1371/journal.pone.0256368. PMID: 34411178; PMCID: PMC8376054.
  8. Leisman DE, Goldman C, Doerfler ME, Masick KD, Dries S, Hamilton E, Narasimhan M, Zaidi G, D’Amore JA, D’Angelo JK. Patterns and Outcomes Associated With Timeliness of Initial Crystalloid Resuscitation in a Prospective Sepsis and Septic Shock Cohort. Crit Care Med. 2017 Oct;45(10):1596–1606. doi: 10.1097/CCM.0000000000002574. PMID: 28671898.
  9. Abou Dagher G, Hajjar K, Khoury C, El Hajj N, Kanso M, Makki M, Mailhac A, Bou Chebl R. Outcomes of patients with systolic heart failure presenting with sepsis to the emergency department of a tertiary hospital: a retrospective chart review study from Lebanon. BMJ Open. 2018 Aug 1;8(7):e022185. doi: 10.1136/bmjopen-2018-022185. PMID: 30068620; PMCID: PMC6074621.
  10. Chebl RB, Berbari I, Safa R, Shami A, Sabra M, Jamali S, Makki M, Tamim H, Dagher GA. Clinical Outcome of Septic Patients With Heart Failure With Preserved Ejection Fraction Presenting to the Emergency Department of a Tertiary Hospital: A Retrospective Cohort Study. Front Med (Lausanne). 2020 Oct 30;7:517999. doi: 10.3389/fmed.2020.517999. PMID: 33195290; PMCID: PMC7662680.
  11. Truong TN, Dunn AS, McCardle K, Glasser A, Huprikar S, Poor H, Raucher B, Poeran J. Adherence to fluid resuscitation guidelines and outcomes in patients with septic shock: Reassessing the “one-size-fits-all” approach. J Crit Care. 2019 Jun;51:94–98. doi: 10.1016/j.jcrc.2019.02.006. Epub 2019 Feb 5. PMID: 30784983.
  12. Khan RA, Khan NA, Bauer SR, Li M, Duggal A, Wang X, Reddy AJ. Association Between Volume of Fluid Resuscitation and Intubation in High-Risk Patients With Sepsis, Heart Failure, End-Stage Renal Disease, and Cirrhosis. Chest. 2020 Feb;157(2):286–292. doi: 10.1016/j.chest.2019.09.029. Epub 2019 Oct 14. PMID: 31622591.
  13. Pence M, Tran QK, Shesser R, Payette C, Pourmand A. Outcomes of CMS-mandated fluid administration among fluid-overloaded patients with sepsis: A systematic review and meta-analysis. Am J Emerg Med. 2022 May;55:157–166. doi: 10.1016/j.ajem.2022.03.004. Epub 2022 Mar 10. PMID: 35338881.
  14. Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis. Am J Emerg Med. 2023 Nov;73:34–39. doi: 10.1016/j.ajem.2023.08.006. Epub 2023 Aug 9. PMID: 37597449.
  15. Bharwani A, Pérez ML, Englesakis M, et al. Protocol for a systematic review and meta-analysis assessing conservative versus liberal intravenous fluid administration in patients with sepsis or septic shock at risk of fluid overload. BMJ Open. 2023;13(5):e069601. Published 2023 May 24. doi:10.1136/bmjopen-2022-069601
  16. Weng J, Xu Z, Song J, Liu C, Jin H, Cheng Q, Zhou X, He D, Yang J, Lin J, Wang L, Chen C, Wang Z. Optimal fluid resuscitation targets in septic patients with acutely decompensated heart failure. BMC Med. 2024 Oct 24;22(1):492. Doi: 10.1186/s12916-024-03715-2. PMID: 39448976; PMCID: PMC11520127.
  17. Beagle AJ, Prasad PA, Hubbard CC, Walderich S, Oreper S, Abe-Jones Y, Fang MC, Kangelaris KN. Associations Between Volume of Early Intravenous Fluid and Hospital Outcomes in Septic Patients With and Without Heart Failure: A Retrospective Cohort Study. Crit Care Explor. 2024 Apr 26;6(5):e1082. doi: 10.1097/CCE.0000000000001082. PMID: 38694845; PMCID: PMC11057813.
  18. Kuttab HI, Lykins JD, Hughes MD, Wroblewski K, Keast EP, Kukoyi O, Kopec JA, Hall S, Ward MA. Evaluation and Predictors of Fluid Resuscitation in Patients With Severe Sepsis and Septic Shock. Crit Care Med. 2019 Nov;47(11):1582–1590. doi: 10.1097/CCM.0000000000003960. PMID: 31393324; PMCID: PMC8096207.
  19. Ehrman RR, Ottenhoff JD, Favot MJ, Harrison NE, Khait L, Welch RD, Levy PD, Sherwin RL. Do septic patients with reduced left ventricular ejection fraction require a low-volume resuscitative strategy? Am J Emerg Med. 2022 Feb;52:187–190. doi: 10.1016/j.ajem.2021.11.046. Epub 2021 Dec 8. PMID: 34952322.
  20. Al Abbasi B, Torres P, Ramos-Tuarez F, Chen K, Avila G, Ceka E, Chacon AR, De Diego G, Bornmann CR, Ghumman W, Chait R, Pino JE. Implementation of the Surviving Sepsis Campaign in Patients With Heart Failure: Gender-Specific Outcomes. Cureus. 2020 Jul 11;12(7):e9140. doi: 10.7759/cureus.9140. PMID: 32789078; PMCID: PMC7417181.
  21. Palmieri V, Innocenti F, Guzzo A, Guerrini E, Vignaroli D, Pini R. Left Ventricular Systolic Longitudinal Function as Predictor of Outcome in Patients With Sepsis. Circ Cardiovasc Imaging. 2015;8(11):e003865. doi:10.1161/CIRCIMAGING.115.003865
  22. Hai PD, Binh NT, Hien NVQ, et al. Prognostic Role of Left Ventricular Systolic Function Measured by Speckle Tracking Echocardiography in Septic Shock. Biomed Res Int. 2020;2020:7927353. Published 2020 Oct 21. doi:10.1155/2020/7927353
  23. Singh H, Ramai D, Patel H, Iskandir M, Sachdev S, Rai R, Patolia J, Hassen GW. B-Type Natriuretic Peptide: A Predictor for Mortality, Intensive Care Unit Length of Stay, and Hospital Length of Stay in Patients With Resolving Sepsis. Cardiol Res. 2017 Dec;8(6):271–275. doi: 10.14740/cr605w. Epub 2017 Dec 22. PMID: 29317968; PMCID: PMC5755657.
  24. Dong N, Gao N, Hu W, Mu Y, Pang L. Association of Fluid Management With Mortality of Sepsis Patients With Congestive Heart Failure: A Retrospective Cohort Study. Front Med (Lausanne). 2022 Mar 2;9:714384. doi: 10.3389/fmed.2022.714384. PMID: 35308491; PMCID: PMC8924446.
  25. Yoo MS, Zhu S, Lu Y, Greene JD, Hammer HL, Iberti CT, Nemazie S, Ananias MP, McCarthy CM, O’Malley RM, Young KL, Reed KO, Martinez RA, Cheung K, Liu VX. Association of Positive Fluid Balance at Discharge After Sepsis Management With 30-Day Readmission. JAMA Netw Open. 2021 Jun 1;4(6):e216105. doi: 10.1001/jamanetworkopen.2021.6105. PMID: 34086036; PMCID: PMC8178709.
  26. Geri G, Vignon P, Aubry A, Fedou AL, Charron C, Silva S, Repessé X, Vieillard-Baron A. Cardiovascular clusters in septic shock combining clinical and echocardiographic parameters: a post hoc analysis. Intensive Care Med. 2019 May;45(5):657–667. doi: 10.1007/s00134-019-05596-z. Epub 2019 Mar 19. PMID: 30888443.
  27. Asllanaj B, Benge E, Bae J, McWhorter Y. Fluid management in septic patients with pulmonary hypertension, review of the literature. Front Cardiovasc Med. 2023 Mar 2;10:1096871. doi: 10.3389/fcvm.2023.1096871. PMID: 36937900; PMCID: PMC10017881.
  28. Krantz MJ, Rudo T, Horvath B, Gregory E, Farasat M, Gore O, Mehler PS. The E/e’ Ratio: As “Critical” As the Left Ventricular Ejection Fraction? Crit Pathw Cardiol. 2022 Jun 1;21(2):93–95. doi: 10.1097/HPC.0000000000000288. Epub 2022 Apr 14. PMID: 35604775.
  29. Chiem AT, Turner E. Utilizing left ventricular outflow tract velocity changes to predict fluid responsiveness in septic patients: a case report. Am J Emerg Med. 2014;32(3):289.e3–289.e289006. doi:10.1016/j.ajem.2013.10.006
  30. Urina Jassir D, Chaanine AH, Desai S, Rajapreyar I, Le Jemtel TH. Therapeutic Dilemmas in Mixed Septic-Cardiogenic Shock. Am J Med. 2023 Jan;136(1):27–32. doi: 10.1016/j.amjmed.2022.09.022. Epub 2022 Oct 14. PMID: 36252709.
DOI: https://doi.org/10.2478/jccm-2026-0005 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
Language: English
Page range: 20 - 27
Submitted on: May 9, 2025
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Accepted on: Nov 13, 2025
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Published on: Jan 30, 2026
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2026 Maxwell Ward, Roshan Acharya, Anthony Loschner, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.