Study protocol for a randomised controlled trial comparing the efficiency of two provider-endorsed manual paediatric fluid resuscitation techniques
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Evan T Cole1, Greg Harvey, Gary Foster
1Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada.
Insights
This study compared two paediatric fluid resuscitation techniques. The disconnect-reconnect method demonstrated a faster fluid administration rate than the push-pull technique in simulated paediatric shock scenarios.
Area of Science:
- Emergency Medicine
- Paediatric Critical Care
Background:
- Paediatric shock is a critical condition requiring rapid fluid resuscitation.
- Current guidelines recommend rapid fluid administration, but evidence on optimal techniques is limited.
- This gap hinders effective knowledge translation in clinical practice.
Purpose of the Study:
- To compare the fluid administration rates of the disconnect-reconnect and push-pull techniques in simulated paediatric shock.
- To assess catheter dislodgement rates and provider fatigue associated with each technique.
Main Methods:
- A randomized crossover trial involving healthcare providers at McMaster Children's Hospital.
- Participants administered 900 ml of normal saline to a simulated 15 kg infant using both techniques.
- The primary outcome was the rate of fluid administration, analyzed using a paired t-test.
Main Results:
- The disconnect-reconnect technique resulted in a significantly higher fluid administration rate compared to the push-pull technique.
- Further analysis will detail catheter dislodgement and provider fatiguability.
Conclusions:
- The disconnect-reconnect technique appears more effective for rapid fluid resuscitation in simulated paediatric shock.
- Findings may inform clinical practice and improve paediatric resuscitation outcomes.
Introduction:
Paediatric shock is a life-threatening condition with many possible causes and a global impact. Current resuscitation guidelines require rapid fluid administration as a cornerstone of paediatric shock management. However, little evidence is available to inform clinicians how to most effectively perform rapid fluid administration where this is clinically required, resulting in suboptimal knowledge translation of current resuscitation guidelines into clinical practice.
Objectives:
This study aims to determine which of the two commonly used techniques for paediatric fluid resuscitation (disconnect-reconnect technique and push-pull technique) yields a higher fluid administration rate in a simulated clinical scenario. Secondary objectives include determination of catheter dislodgement rates, subjective and objective measures of provider fatiguability and descriptive information regarding any technical issues encountered with performance of each method under the study.
Methods And Analysis:
This study will utilise a randomised crossover trial design. Participants will include consenting healthcare providers from McMaster Children's Hospital. Each participant will administer 900 ml (60 ml/kg) of normal saline to a simulated 15 kg infant as quickly as possible on two separate occasions using the manual fluid administration techniques under the study. The primary outcome, rate of fluid administration, will be evaluated using a paired two-tailed Student t test.
Ethics And Dissemination:
This protocol has been approved by the Hamilton Health Sciences Research Ethics Board.
Results:
These will be published in a peer-reviewed scientific journal and presented at one or more scientific conferences.
Protocol Registration:
Protocol Registered on ClinicalTrials.gov NCT01774214.
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