Rapid Fluid Resuscitation in Pediatrics: Testing the American College of Critical Care Medicine Guideline

Stoner, Michael J.; Goodman, Deborah G.; Cohen, Daniel M.; Fernández, Soledad; Hall, Mark W.

doi:10.1016/j.annemergmed.2007.06.482

Cited by 46 publications

(47 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although previous research has separately evaluated these two techniques,19 20 their relative efficiency in the hands of typical healthcare providers has not been studied.…”

Section: Introductionmentioning

confidence: 99%

Rapid paediatric fluid resuscitation: a randomised controlled trial comparing the efficiency of two provider-endorsed manual paediatric fluid resuscitation techniques in a simulated setting

et al. 2014

View full text Add to dashboard Cite

ObjectivesManual techniques of intravascular fluid administration are commonly used during paediatric resuscitation, although it is unclear which technique is most efficient in the hands of typical healthcare providers. We compared the rate of fluid administration achieved with the disconnect–reconnect and push–pull manual syringe techniques for paediatric fluid resuscitation in a simulated setting.MethodsThis study utilised a randomised crossover trial design and enrolled 16 consenting healthcare provider participants from a Canadian paediatric tertiary care centre. The study was conducted in a non-clinical setting using a model simulating a 15 kg child in decompensated shock. Participants administered 900 mL (60 mL/kg) of normal saline to the simulated patient using each of the two techniques under study. The primary outcome was the rate of fluid administration, as determined by two blinded independent video reviewers. We also collected participant demographic data and evaluated other secondary outcomes including total volume administered, number of catheter dislodgements, number of technical errors, and subjective and objective measures of provider fatigue.ResultsAll 16 participants completed the trial. The mean (SD) rate of fluid administration (mL/s) was greater for the disconnect–reconnect technique at 1.77 (0.145) than it was for the push–pull technique at 1.62 (0.226), with a mean difference of 0.15 (95% CI 0.055 to 0.251; p=0.005). There was no difference in mean volume administered (p=0.778) or participant self-reported fatigue (p=0.736) between techniques. No catheter dislodgement events occurred.ConclusionsThe disconnect–reconnect technique allowed for the fastest rate of fluid administration, suggesting that use of this technique may be preferable in situations requiring rapid resuscitation. These findings may help to inform future iterations of paediatric resuscitation guidelines.Trial registration numberThis trial was registered at ClinicalTrials.gov [NCT01774214] prior to enrolling the first participant.

show abstract

“…Although previous research has separately evaluated these two techniques,19 20 their relative efficiency in the hands of typical healthcare providers has not been studied.…”

Section: Introductionmentioning

confidence: 99%

Rapid paediatric fluid resuscitation: a randomised controlled trial comparing the efficiency of two provider-endorsed manual paediatric fluid resuscitation techniques in a simulated setting

et al. 2014

View full text Add to dashboard Cite

show abstract

“…It was determined that use of an IV pump for fluid delivery was a major contributor to poor adherence, as IV pump characteristics limit the administration of 60 mL/kg of IV fluid within 60 minutes to children weighing #16 kg. 17 …”

Section: Figurementioning

confidence: 99%

Improving Adherence to PALS Septic Shock Guidelines

Paul

Melendez

Stack³

et al. 2014

Pediatrics

151

117

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES:Few studies have demonstrated improvement in adherence to Pediatric Advanced Life Support guidelines for severe sepsis and septic shock. We sought to improve adherence to national guidelines for children with septic shock in a pediatric emergency department with poor guideline adherence. METHODS:Prospective cohort study of children presenting to a tertiary care pediatric emergency department with septic shock. Quality improvement (QI) interventions, including repeated plan-do-study-act cycles, were used to improve adherence to a 5-component sepsis bundle, including timely (1) recognition of septic shock, (2) vascular access, (3) administration of intravenous (IV) fluid, (4) antibiotics, and (5) vasoactive agents. The intervention focused on IV fluid delivery as a key driver impacting bundle adherence, and adherence was measured using statistical process control methodology.RESULTS: Two-hundred forty-two patients were included: 126 subjects before the intervention (November 2009 to March 2011), and 116 patients during the QI intervention (October 2011 to May 2013). We achieved 100% adherence for all metrics, including (1) administration of 60 mL/kg IV fluid within 60 minutes (increased from baseline adherence rate of 37%), (2) administration of vasoactive agents within 60 minutes (baseline rate of 35%), and (3) 5-component bundle adherence (baseline rate of 19%). Improvement was sustained over 9 months. The number of septic shock cases between each death from this condition increased after implementation of the QI intervention.CONCLUSIONS: Using QI methodology, we have demonstrated improved adherence to national guidelines for severe sepsis and septic shock.

show abstract

“…The ACCM now recommends rapid fluid resuscitation of up to 60 ml/kg of isotonic intravenous fluid within the first 15 min for pediatric patients in septic shock [9]. These recommendations emphasize an initial rapid clinical assessment followed by continued reassessments during resuscitation.…”

Section: Rapid Fluid Resuscitation In Septic Shockmentioning

confidence: 98%

“…Given the ACCM guidelines' recommendation of as much as 60 ml/kg of fluid resuscitation in septic shock, Stoner and Goodman [9] tested the feasibility of administering such a large volume within the recommended time frame of 15 min. They compared methods of rapid fluid resuscitation via pressure bag, manual push-pull system, or by gravity in the pediatric patient.…”

Section: Key Pointsmentioning

confidence: 99%

Pediatric rapid fluid resuscitation

Simpson

Teach

2011

Current Opinion in Pediatrics

View full text Add to dashboard Cite

Rapid fluid resuscitation is most commonly used for children with moderate-to-severe dehydration, or for patients in shock to restore circulation. Concerns regarding potential for fluid overload and electrolyte disturbances and regarding the method of rehydration (i.e., enteral versus parenteral) raise some debate about the safety and efficacy of rapid fluid resuscitation in the pediatric patient. Recent studies show that early, aggressive fluid resuscitation of up to 60 ml/kg within 1-2 h may be necessary to replenish circulating intravascular fluid volume. Complications of severe electrolyte disturbances, cerebral edema, or uncontrolled hemorrhage are uncommon and can often be avoided with early clinical assessment and reassessments throughout the resuscitation. In the mildly to moderately dehydrated child, enteral fluid resuscitation with the aid of an antiemetic such as ondansetron can be as effective and efficient as intravenous fluid resuscitation.

show abstract

Rapid Fluid Resuscitation in Pediatrics: Testing the American College of Critical Care Medicine Guideline

Cited by 46 publications

References 9 publications

Rapid paediatric fluid resuscitation: a randomised controlled trial comparing the efficiency of two provider-endorsed manual paediatric fluid resuscitation techniques in a simulated setting

Rapid paediatric fluid resuscitation: a randomised controlled trial comparing the efficiency of two provider-endorsed manual paediatric fluid resuscitation techniques in a simulated setting

Improving Adherence to PALS Septic Shock Guidelines

Pediatric rapid fluid resuscitation

Contact Info

Product

Resources

About