Pediatric rapid fluid resuscitation

Simpson, Joelle; Teach, Stephen J.

doi:10.1097/mop.0b013e3283460599

Cited by 13 publications

(3 citation statements)

References 44 publications

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“…With a lack of evidence of the benefit of permissive hypotension in pediatric patients, the current standard of care is primarily maintaining tissue perfusion with crystalloid boluses until definitive control of hemorrhage is available. [13] Interestingly, a retrospective study by Vella, et al . examined 154 pediatric trauma patients that presented to a level 1 trauma center over one year and found that 70% of patients did not receive a fluid because it was deemed not necessary by the attending ER physician or trauma surgeon.…”

Section: Pediatric Cardiovascular Systemmentioning

confidence: 99%

Pre-hospital care of pediatric patients with trauma

Seid

Ramaiah

Grabinsky

2012

Int J Crit Illn Inj Sci

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Prehospital pediatric care is an important component in the treatment of the injured child, as the prehospital responders are the first medical providers performing life saving and directed medical care. Traumatic injuries are the leading cause of morbidity and mortality in the pediatric patient population. Nevertheless, for most prehospital provider it is a rare event to treat pediatric trauma patients and there is a still existing gap between the quality of care for pediatric patients compared to adults. To improve pediatric prehospital trauma care more provider need to be trained in identifying the specific differences between adult and pediatric patients.

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Section: Pediatric Cardiovascular Systemmentioning

confidence: 99%

Pre-hospital care of pediatric patients with trauma

Seid

Ramaiah

Grabinsky

2012

Int J Crit Illn Inj Sci

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“…When FEAST was released, rapid, large-volume fluid resuscitation was the norm in paediatric septic shock, and in other conditions involving fluid loss in children 53 . It may be impossible to directly translate the findings of FEAST into practice change internationally; however, as it represents the current purest examination of the effects of FBT in isolation in critically ill children, it should have prompted further investigation into the safety and efficacy of FBT in this population in the developed world.…”

Section: After the Feast A Famine?mentioning

confidence: 99%

Coming Full Circle: Thirty Years of Paediatric Fluid Resuscitation

Glassford¹,

Gelbart

Bellomo

2017

Anaesth Intensive Care

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Fluid bolus therapy (FBT) is a cornerstone of the management of the septic child, but clinical research in this field is challenging to perform, and hard to interpret. The evidence base for independent benefit from liberal FBT in the developed world is limited, and the Fluid Expansion as Supportive Therapy (FEAST) trial has led to conservative changes in the World Health Organization-recommended approach to FBT in resource-poor settings. Trials in the intensive care unit (ICU) and emergency department settings post-FEAST have continued to explore liberal FBT strategies as the norm, despite a strong signal associating fluid accumulation with pulmonary pathology in the paediatric population. Modern clinical trial methodology may ameliorate the traditional challenges of performing randomised interventional trials in critically ill children. Such trials could examine differing strategies of fluid resuscitation, or compare early FBT to early vasoactive agent use. Given the ubiquity of FBT and the potential for harm, appropriately powered examinations of the efficacy of FBT compared to alternative interventions in the paediatric emergency and ICU settings in the developed world appear justified and warranted.

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“…7,8 However, some patients are unable to tolerate oral rehydration, and IV crystalloid is frequently used. [8][9][10][11] Ketosis may complicate dehydration when illness prevents the intake of adequate carbohydrates, leading to increased free fatty acid breakdown and ketogenesis. 5,12 Ketoacidosis occurs when there is no carbohydrate substrate and thus no insulin secretion, triggering lipolysis and ketogenesis to prevent hypoglycemia.…”

Section: Introductionmentioning

confidence: 99%

Does the addition of dextrose to IV crystalloid therapy provide clinical benefit in acute dehydration? A systematic review and meta-analysis

Grigsby

Herron

Hunter

2019

CJEM

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ObjectivesIntravenous dextrose aids in the resolution of ketosis in dehydrated patients not tolerating oral glucose and is often recommended in this clinical scenario. Our aim was to determine whether the addition of dextrose to intravenous rehydration solutions results in decreased hospital admissions or other clinically important benefits among dehydrated children or adults.MethodsMEDLINE, EMBASE, Web of Science, SCOPUS, and the Cochrane Library were searched by a medical librarian from inception through November 2017. The inclusion criteria were randomized controlled trials comparing dextrose containing intravenous solutions with intravenous solutions without dextrose in patients being treated for dehydration, and not already hospitalized.ResultsThe database and bibliographies search identified 1,472 unique citations. Only two trials (N = 333) met the inclusion criteria. Both compared normal saline with solutions of dextrose in normal saline. There was no statistically significant difference in admission rates (relative risk = 0.83; 95% confidence interval = 0.62 to 1.10) or revisits (relative risk = 0.54; 95% confidence interval = 0.24 to 1.22). Heterogeneity was low (I2 = 0). No other outcome results were eligible for pooling, but neither study found differences in any clinical outcomes. No adverse events were reported in either trial.ConclusionsThe addition of dextrose to intravenous saline has not been shown to improve clinical outcomes in dehydrated children presenting to the emergency department with gastroenteritis, but the confidence intervals around the estimate of effect are wide and include the possibility of substantial benefit.

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Pediatric rapid fluid resuscitation

Cited by 13 publications

References 44 publications

Pre-hospital care of pediatric patients with trauma

Pre-hospital care of pediatric patients with trauma

Coming Full Circle: Thirty Years of Paediatric Fluid Resuscitation

Does the addition of dextrose to IV crystalloid therapy provide clinical benefit in acute dehydration? A systematic review and meta-analysis

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