Overall, the majority of studies di

Overall, the majority of studies discussed have found anssociation between increased fluid administration (ie, with ositive fluid balance or large fluid volume administration) and increased mortality. Evaluation of these studies is limed by an inability to assess fluid administration relative to isease severity (ie, higher severity of illness required increased fluid) and type of fluid received (eg, colloid, balanced crystalloid, saline). Further, these studies vary in terms of their methodology, with patients being classified ccording to either their total fluid balance or the amount of fluid received. There was a consistent increase in mortality when analyzing patients by their fluid balance, but the association is not as clear when considering the amount of fluidsreceived. This is due to the lower 90-day mortality reported for patients who received more than the overall median amount of fluid at day 3 of septic shock. Although outcomes of patients according to the total amount of fluid received were analyzed, the authors did not report mortality differences when comparing by their overall fluid balance. While this finding contrasts results from other studies, this difference only occurred in a subgroup analysis of patients with shock persisting over 3 days. The results of this study should be evaluated with caution until more studies consistently demonstrate a lower mortality in patients who receive more fluid as both the amount of fluid received and a fluid balance.