A systematic review and meta-analysis examined active fluid de-resuscitation strategies in patients with septic shock, including diuretics and active fluid removal. The review included 13 studies, with five randomised controlled trials contributing to the quantitative analysis. The evidence did not show a mortality benefit from active de-resuscitation compared with usual care. Although some studies achieved greater fluid separation, patient-centred outcomes were generally unchanged, and the evidence base was limited by small samples and heterogeneity in the interventions used. The paper is highly relevant to CritiCARE's focus on de-resuscitation and fluid stewardship. It reinforces a key distinction: reducing a patient's fluid balance is not automatically the same as improving survival. For clinicians, active fluid removal should therefore be linked to an identifiable clinical problem such as fluid overload, venous congestion or failure to tolerate additional fluid—not simply to a desire to make the balance more negative. The practical approach is phase-based resuscitation: give fluid when there is a clear indication, reassess whether the patient remains fluid responsive, and consider fluid removal once the haemodynamic objective has been achieved and congestion becomes harmful. The review supports careful, patient-specific de-resuscitation while highlighting the need for better randomised evidence.