AimsThe management of severe sepsis and septic shock in children is complex and time critical and requires prompt recognition and secondly early administration of antibiotics and fluid resuscitation. The American College of Critical Care Medicine- Paediatric Advanced Life Support (ACCM-APLS 2007) Clinical Guideline for Haemodynamic Support of Neonates and Children with Septic Shock states that within 60 min one should be able to fluid resuscitate up to 60 ml/kg and if needed start inotropes to restore circulation. Therefore the research question we asked is ‘What is the recommended minimal gauge cannula for fluid resuscitation in each patient group to meet the first hour goals set by the American College of Critical Care Medicine (ACCM) for Paediatric Septic Shock?MethodThe study compared the total time taken to administer 60 ml/kg of fluid through different gauge cannula in the four patient groups using a pressurised delivery system. The four patient groups tested had a working weight of; 4 kg, 12 kg, 25 kg and 50 kg. The study was conducted in a non-clinical setting using a model simulating a child in septic shock. Under controlled conditions, one volunteer administered the 60 ml/kg volume in aliquots of 20 ml/kg to the simulated patient. The primary outcome was the total time taken to administer 60 ml/kg of 0.9% saline including time for preparation and re-assessment and secondary outcomes analysed were the flow rate (ml/min), average and fastest time to administer a 20 ml/kg bolus and the time taken to bolus with and without a cannula connector.ResultsTo achieve the ACCM-PALS first hour goal for rapid fluid resuscitation in Paediatric Septic Shock one should aim to use the following recommended minimum size and brand of cannula per patient group as per the table below:Abstract G303(P) Table 1Recommended minimum size and brand of cannula per patient groupPatient WeightRecommended size and brand of cannulaAverage time to administer 20 ml/kg bolus of 0.9% salineTime to administer 60 ml/kg (including time for preparation and standardised re-assessment)4 kgYellow 24G Jelco1 min and 18 s11 min and 10 s12 kgYellow 24G Jelco5 min and 2 s28 min and 56 s25 kgBlue 22G Venflon9 min and 36 s37 min and 41 s50 kgGreen 18G Venflon12 min and 42 s49 min and 4 sDiscussionThis study provides practical recommendations for time-critical fluid resuscitation in sepsis and should lead to further research in the clinical setting. It should also support future iterations of Paediatric Resuscitation Guidelines regarding the optimal Paediatric fluid resuscitation technique.