For years, septic shock management has emphasized aggressive fluid administration early in resuscitation. However, growing evidence suggested that excessive fluid accumulation may contribute to organ dysfunction, prolonged ventilation, and worse outcomes.
At the same time, clinicians increasingly questioned whether earlier vasopressor initiation could reduce unnecessary fluid exposure.
The CLOVERS trial was designed to address this debate. Published in 2023, CLOVERS randomized patients with sepsis-induced hypotension to either a restrictive fluid strategy emphasizing earlier vasopressor use or a liberal fluid strategy emphasizing continued intravenous fluid administration.
Patients had already received an initial fluid bolus prior to enrollment. The primary outcome was mortality before discharge home by day 90.