How should we resuscitate patients with septic shock in the emergency department? It remains one of the most controversial questions in emergency medicine and critical care. For years, clinicians have debated whether early aggressive fluid resuscitation should remain the cornerstone of sepsis management, or whether earlier vasopressor use might offer a safer and more effective approach. Presented this week at Critical Care Reviews 2026 and simultaneously published in the New England Journal of Medicine, the ARISE-FLUIDS trial is one of the largest randomised studies to compare early vasopressors and restricted fluids against a more traditional fluid-based resuscitation strategy in septic shock. The results are important, thought-provoking and, perhaps surprisingly, reassuring for clinicians on both sides of the debate.
