Fluid resuscitation of shock in children: what, whence and whither?

Inwald, David; Butt, Warwick; Tasker, Robert C.

doi:10.1007/s00134-015-3905-z

Cited by 15 publications

(9 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the larger study, children who had signs of shock that resolved quickly were included in the appropriate fluid therapy group; the median fluid volumes given to children who died (32.9 ml/kg) were higher than those given to survivors (20 ml/kg) [ 10 , 30 ]. Theoretically, FBT could cause harm by several mechanisms: rapid reduction in sympathetically mediated compensatory mechanisms; treatment-induced hyperchloremic metabolic acidosis; ischemia-reperfusion injury; fluid overload; and endothelial glycocalyx degradation [ 8 , 31 – 33 ]. The endothelial glycocalyx has important functions in regulating vasomotor tone, oncotic gradient, endothelial porosity, microvascular thrombosis, oxidative stress, and endothelial adhesion of platelets, red blood cells, and white blood cells [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Timing of antibiotics, volume, and vasoactive infusions in children with sepsis admitted to intensive care

Paridon¹,

Sheppard

et al. 2015

Crit Care

View full text Add to dashboard Cite

IntroductionEarly administration of antibiotics for sepsis, and of fluid boluses and vasoactive agents for septic shock, is recommended. Evidence for this in children is limited.MethodsThe Alberta Sepsis Network prospectively enrolled eligible children admitted to the Pediatric Intensive Care Unit (PICU) with sepsis from 04/2012-10/2014. Demographics, severity of illness, and outcomes variables were prospectively entered into the ASN database after deferred consent. Timing of interventions were determined by retrospective chart review using a study manual and case-report-form. We aimed to determine the association of intervention timing and outcome in children with sepsis. Univariate (t-test and Fisher’s Exact) and multiple linear regression statistics evaluated predictors of outcomes of PICU length of stay (LOS) and ventilation days.ResultsSeventy-nine children, age median 60 (IQR 22–133) months, 40 (51 %) female, 39 (49 %) with severe underlying co-morbidity, 44 (56 %) with septic shock, and median PRISM-III 10.5 [IQR 6.0-17.0] were enrolled. Most patients presented in an ED: 36 (46 %) at an outlying hospital ED, and 21 (27 %) at the Children’s Hospital ED. Most infections were pneumonia with/without empyema (42, 53 %), meningitis (11, 14 %), or bacteremia (10, 13 %). The time from presentation to acceptable antibiotic administration was a median of 115.0 [IQR 59.0-323.0] minutes; 20 (25 %) of patients received their antibiotics in the first hour from presentation. Independent predictors of PICU LOS were PRISM-III, and severe underlying co-morbidity, but not time to antibiotics. In the septic shock subgroup, the volume of fluid boluses given in the first 2 hours was independently associated with longer PICU LOS (effect size 0.22 days; 95 % CI 0.5, 0.38; per ml/kg). Independent predictors of ventilator days were PRISM-III score and severe underlying co-morbidity. In the septic shock subgroup, volume of fluid boluses in the first 2 hours was independently associated with more ventilator days (effect size 0.09 days; 95 % CI 0.02, 0.15; per ml/kg).ConclusionHigher volume of early fluid boluses in children with sepsis and septic shock was independently associated with longer PICU LOS and ventilator days. More study on the benefits and harms of fluid bolus therapy in children are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-1010-x) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

Timing of antibiotics, volume, and vasoactive infusions in children with sepsis admitted to intensive care

Paridon¹,

Sheppard

et al. 2015

Crit Care

View full text Add to dashboard Cite

show abstract

“…In the UK, children presenting to emergency departments (EDs) with severe sepsis and discussed with a paediatric intensive care retrieval service have a reported mortality of up to 17% 9. With emerging data suggesting that excessive fluid administration is associated with worse outcomes in paediatric intensive care unit (PICU),10–14 the optimal amount of fluid for resuscitation for children presenting with septic shock remains an important unanswered question.…”

Section: Introductionmentioning

confidence: 99%

Restricted fluid bolus volume in early septic shock: results of the Fluids in Shock pilot trial

et al. 2018

View full text Add to dashboard Cite

ObjectiveTo determine the feasibility of Fluids in Shock, a randomised controlled trial (RCT) of restricted fluid bolus volume (10 mL/kg) versus recommended practice (20 mL/kg).DesignNine-month pilot RCT with embedded mixed-method perspectives study.Setting13 hospitals in England.PatientsChildren presenting to emergency departments with suspected infection and shock after 20 mL/kg fluid.InterventionsPatients were randomly allocated (1:1) to further 10 or 20 mL/kg fluid boluses every 15 min for up to 4 hours if still in shock.Main outcome measuresThese were based on progression criteria, including recruitment and retention, protocol adherence, separation, potential trial outcome measures, and parent and staff perspectives.ResultsSeventy-five participants were randomised; two were withdrawn. 23 (59%) of 39 in the 10 mL/kg arm and 25 (74%) of 34 in the 20 mL/kg arm required a single trial bolus before the shock resolved. 79% of boluses were delivered per protocol in the 10 mL/kg arm and 55% in the 20 mL/kg arm. The volume of study bolus fluid after 4 hours was 44% lower in the 10 mL/kg group (mean 14.5 vs 27.5 mL/kg). The Paediatric Index of Mortality-2 score was 2.1 (IQR 1.6–2.7) in the 10 mL/kg group and 2.0 (IQR 1.6–2.5) in the 20 mL/kg group. There were no deaths. Length of hospital stay, paediatric intensive care unit (PICU) admissions and PICU-free days at 30 days did not differ significantly between the groups. In the perspectives study, the trial was generally supported, although some problems with protocol adherence were described.ConclusionsParticipants were not as unwell as expected. A larger trial is not feasible in its current design in the UK.Trial registration numberISRCTN15244462.

show abstract

“…What should be the role of fluid bolus in PICU patients? The Canadian 'SQUEEZE' study (septic shock reversal is quicker in paediatric patients randomized to an early goal directed fluid-sparing strategy vs. usual care) (NCT01973907) and the UK's 'FiSh' study (Fluids in Shock: ISRCTN15244462) (UK Health Technology Assessment Programme 13/04/105) may start to fill this evidence gap [38].…”

Section: Resuscitation With Fluidsmentioning

confidence: 99%