Crystalloid fluid administration was associated with outcomes in pediatric patients with severe sepsis or septic shock

Abstract

Intravenous fluid prescription plays an important role in sepsis management, which may be associated with patient prognosis. The objective of the present study was to determine if the administration of crystalloid fluids is associated with clinical outcome for patients with severe sepsis and septic shock.The medical records of 79 patients with severe sepsis or septic shock at an academic tertiary care hospital between 2011 and 2016 were reviewed retrospectively. The patients were dichotomized based on the median 3-day amount of corrected crystalloid fluids as low (<193 mL/kg) versus high (>193 mL/kg). The primary outcome measure was mortality. Secondary outcome measures included length of stay in the pediatric intensive care unit (PICU), usage of mechanical ventilation, etc.The most common bacterial pathogens were Escherichia coli and Klebsiella spp. with a strikingly high number of multidrug-resistant infections (10.1%). The most common site of infection was of abdominal origin. Patients who received larger amounts of crystalloids were more likely to have lower weight and underlying comorbidities (high PRISM score). Although fluid intake was different in the 2 groups, output volumes were almost the same; therefore, a positive fluid balance was present in the high crystalloid patients. The incidence of mortality increased as the accumulated 3-day amount of crystalloid fluids administered increased. The total length of stay in the PICU was longer for patients who received high volume crystalloid fluid (15.8 ± 7.8 days) than for patients who received the lower volume (9.7 ± 5.3 days, P = .026).A higher amount of 3-day crystalloid administration was unfavorable for postoperative outcomes in children with sepsis and septic shock; these patients experienced higher PICU mortality, longer PICU stays, and more ventilator days. More study on the benefits and harms of fluid in children are needed to improve patient safety and the quality of care that would facilitate better outcomes.

Prognostic factors and models to predict pediatric sepsis mortality: A scoping review

“…Crystalloid fluid administration is associated with mortality in pediatric patients with severe sepsis or septic shock. The high crystalloid group (>193 ml/kg body weight) had a higher PICU mortality (46.2% vs. 25%; odds ratio [OR] 2.57; 95% CI, 0.99-6.67; p = 0.041) compared to the low crystalloid group (16).…”

“…Most studies did not specify the timing of mortality. Nine studies reported secondary outcomes such as length of hospital/PICU stay, ventilator requirement, or vasoactive agent usage (5,16,21,22,25,32,38). Mortality rates ranged between 4.8%and 64%.…”

Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

“…[30][31][32] In addition, the EvUp identified 1 RCT 33 that did not directly address the PICO (population, intervention, comparator, outcome) question but provided information about the effect of a fluid bolus on pediatric cardiac index. The EvUp also analyzed the results of 4 nonrandomized studies [34][35][36][37] and 1 study protocol. 38 The Society of Critical Care Medicine's Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children was published in February 2020, 26 immediately before the submission of this publication.…”

Pediatric Life Support

“… 30 , 31 , 32 In addition, the EvUp identified 1 RCT 33 that did not directly address the PICO (population, intervention, comparator, outcome) question but provided information about the effect of a fluid bolus on cardiac index. The EvUp also analysed the results of 4 nonrandomized studies 34 , 35 , 36 , 37 and 1 study protocol. 38 …”