Fluids in Septic Shock (FISSH)

NCT ID: NCT03677102

Last Updated: 2026-02-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE2/PHASE3

Total Enrollment

1096 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-09-09

Study Completion Date

2026-02-28

Brief Summary

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Despite evidence of the physiologic benefits and possible lower mortality associated with low chloride solutions, normal saline remains the most wildly used fluid in the world. Given uncertainty about the impact of lower chloride versus higher chloride solutions on mortality, it is unlikely that clinical practice will change without new and direct randomized controlled trial (RCT) evidence. Editorials published in leading critical care journals have called for RCT's to address this important clinical question. This trial will directly compare low chloride versus normal chloride for resuscitation in septic shock on patient-important outcomes such as mortality and AKI.

Detailed Description

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Severe infection can lead to many complications within the human body including low blood pressure, which is called septic shock. The main treatments for septic shock are intravenous antibiotics and intravenous fluid.

There are many different intravenous fluids available for doctors to use. Each one of these fluids has potential advantages as well as potential disadvantages. Doctors will often look at many things when deciding which fluid to give including the results of bloodwork and the clinical characteristics of the patients themselves. There is limited direction from research studies that using one fluid type is better than another. Some preliminary research in the field has suggested that one specific electrolyte, call chloride, may be harmful when given to patients in high concentrations. Animal research has shown that the administration of high chloride fluids may be harmful to the lungs, kidneys, gastrointestinal and muscle cells. Some intravenous fluids have higher concentrations of chloride than others.

The investigators plan to study the impact of giving patients with severe infection intravenous fluids with either a high chloride concentration (normal saline or high chloride albumin) or a low chloride concentration (Ringers Lactate or low chloride albumin). This trial will build on the earlier pilot, phase 1 study and will look at patient-important outcomes such as rate of death, kidney failure and length of stay in the ICU. This larger study has the potential to guide the care of critically ill patients with infection worldwide.

Conditions

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Sepsis, Septic Shock

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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higher chloride solutions

higher chloride crystalloid (Normal saline - chloride concentration 154 mmol/L)

Group Type ACTIVE_COMPARATOR

higher chloride crystalloid

Intervention Type OTHER

Normal saline (chloride concentration 154 mmol/L)

lower chloride solutions

lower chloride crystalloid (Ringer's lactate - chloride concentration 110 mmol/L)

Group Type ACTIVE_COMPARATOR

lower chloride crystalloid

Intervention Type OTHER

Ringer's Lactate (chloride concentration 110 mmol/L)

Interventions

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higher chloride crystalloid

Normal saline (chloride concentration 154 mmol/L)

Intervention Type OTHER

lower chloride crystalloid

Ringer's Lactate (chloride concentration 110 mmol/L)

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* patients 16 years or greater who meet all of the following:
* require fluid resuscitation for refractory hypotension (systolic blood pressure \<90 mmHg or mean arterial blood pressure\<65 mmHg after 1 Litre bolus over 1 hour or less or organ hypo-perfusion (serum lactate \>4 mmol/L)
* have a clinical suspicion of infection
* are within 6 hours of hospital admission or critical care response team consultation
* are anticipated to require ICU admission

Exclusion Criteria

* intracranial bleed or intracranial hypertension during the index hospital admission
* 10% of body surface area acute burn injury
* bleeding/hemorrhage as likely cause of hypotension
* a lack of commitment to life support
* have previously enrolled in FISSH, or a confounding trial (e.g. a trial examining the effect of other intravenous fluids in septic shock patients)
* been transferred from another hospital or facility \>6 hours since presentation to first hospital
* pre-established end stage renal disease (ESRD) or are receiving hemodialysis (intermittent or continuous) at time of enrolment, or
* been admitted to ICU directly from the operating room or post anaesthetic care unit
Minimum Eligible Age

16 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Physicians' Services Incorporated Foundation

OTHER

Sponsor Role collaborator

Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role collaborator

McMaster University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Bram Rochwerg, MSc,MD,FRCPC

Role: PRINCIPAL_INVESTIGATOR

McMaster University

Locations

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University of Calgary - Foothills Medical Centre

Calgary, Alberta, Canada

Site Status RECRUITING

University of Calgary - Rockyview General Hospital

Calgary, Alberta, Canada

Site Status RECRUITING

Grey Nuns Community Hospital

Edmonton, Alberta, Canada

Site Status RECRUITING

Halifax Infirmary

Halifax, Nova Scotia, Canada

Site Status RECRUITING

Victoria General

Halifax, Nova Scotia, Canada

Site Status RECRUITING

Cape Breton Regional Hospital

Sydney, Nova Scotia, Canada

Site Status RECRUITING

Lakeridge Health - Ajax Pickering

Ajax, Ontario, Canada

Site Status RECRUITING

Brantford General Hospital

Brantford, Ontario, Canada

Site Status RECRUITING

St Joseph's Healthcare

Hamilton, Ontario, Canada

Site Status RECRUITING

Juravinski Hospital-Hamilton Health Sciences

Hamilton, Ontario, Canada

Site Status RECRUITING

Hamilton General Hospital

Hamilton, Ontario, Canada

Site Status RECRUITING

Kingston General Hospital

Kingston, Ontario, Canada

Site Status RECRUITING

London Health Sciences Centre - Victoria Hospital

London, Ontario, Canada

Site Status RECRUITING

London Health Sciences - University Hospital

London, Ontario, Canada

Site Status RECRUITING

Lakeridge Health

Oshawa, Ontario, Canada

Site Status RECRUITING

Niagara Health, St Catharines Site

St. Catharines, Ontario, Canada

Site Status RECRUITING

Unity Health (St. Michael's Hospital)

Toronto, Ontario, Canada

Site Status RECRUITING

Mount Sinai Hospital

Toronto, Ontario, Canada

Site Status RECRUITING

Sunnybrook Health Sciences Centre

Toronto, Ontario, Canada

Site Status RECRUITING

Windsor Regional Hospital - Ouellette Campus

Windsor, Ontario, Canada

Site Status RECRUITING

Windsor Regional Hospital -Metropolitan Campus

Windsor, Ontario, Canada

Site Status RECRUITING

Centre intégré Universitaire de santé et de services sociaux du Nord de l'île de Montréal

Montreal, Quebec, Canada

Site Status RECRUITING

Centre Hospitalier de l'Universite de Montreal (CHUM)

Montreal, Quebec, Canada

Site Status RECRUITING

Centre de recherche du CIUSSS de l'Estrie - CHUS de Sherbrooke

Sherbrooke, Quebec, Canada

Site Status RECRUITING

Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS MCQ)

Trois-Rivières, Quebec, Canada

Site Status RECRUITING

Royal University Hospital

Saskatoon, Saskatchewan, Canada

Site Status RECRUITING

St Paul's Hospital

Saskatoon, Saskatchewan, Canada

Site Status RECRUITING

King Abdulaziz Medical City- Riyadh (KAMC-R)

Riyadh, , Saudi Arabia

Site Status RECRUITING

King Faisal Specialist Hospital & Research Centre

Riyadh, , Saudi Arabia

Site Status RECRUITING

Countries

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Canada Saudi Arabia

Central Contacts

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Bram Rochwerg, MSc,MD,FRCPC

Role: CONTACT

905-521-2100 ext. 42442

Peggy Austin

Role: CONTACT

905-525-9140 ext. 22154

Facility Contacts

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Delphine Roche, M.Sc

Role: primary

(403)-944-8748

Delphine Roche, M.Sc.

Role: primary

(403)-944-8748

Anushka Jayasekara, RC

Role: primary

Sharon Oldford, PhD

Role: primary

902-473-5643

Sharon Oldford, PhD

Role: primary

902-473-5643

Cheryl Furey, RN, BScN

Role: primary

Ankita Das, MBBS, MSc

Role: primary

905-683-2320 ext. 13544

William Dechert, MSc

Role: primary

519-752-7871 ext. 4531

France Clarke, RRT

Role: primary

905-522-1155 ext. 33633

Bram Rochwerg, MSc,MD,FRCPC

Role: primary

905-521-2100 ext. 42442

Tina Millen, RRT

Role: backup

905-719-6133

Lori Hand, RRT

Role: primary

Tracy Boyd, CCRC

Role: primary

613-549-6666 ext. 2608

Eileen Campbell, RN

Role: primary

519-685-8500 ext. 55664

Tracey C Bentall

Role: primary

Eileen Campbell

Role: backup

Barbara Flynn, RN BScN

Role: primary

Sarah Dulmage, ScH

Role: backup

Emily Baker, RC

Role: primary

289-929-9148

Marlene Santos, MD, ACRP

Role: primary

416-864-6060 ext. 2322

Sumesh Shah, CCRP

Role: primary

416-586-4800 ext. 8445

Nicole Marinoff, RN, CCRP

Role: primary

Batul Khumushi, CCRP

Role: primary

519-254-5577 ext. 52899

Batul Khumushi, CCRP

Role: primary

519-254-5577 ext. 52899

Virginie Williams, PhD

Role: primary

514 338 2222 ext. 583-3272

Andrea Gagnon-Hamelin

Role: primary

Marie-Pier Bouchard, RA

Role: primary

Mariana Costa Dias, B.Sc.Inf.

Role: primary

819 697-3333 ext. 64228

Laura Diamond, RC

Role: backup

819-697-3333 ext. 64817

Kelsey Bjorkman, RC

Role: primary

306 715 7886

Kelsey Bjorkman, RC

Role: primary

306-715-7886

Felwa Bin Humaid, BSc

Role: primary

Samar Nouri, CRC

Role: primary

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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1515

Identifier Type: -

Identifier Source: org_study_id

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