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Fluid Bolus Therapy-Based Resuscitation for Severe Sepsis in Hospitalized Children: A Systematic Review
Ben Gelbart1, Neil J Glassford, Rinaldo Bellomo
11Department of Intensive Care, Royal Children's Hospital, Melbourne, VIC, Australia. 2Melbourne Children's Research Institute, Parkville, VIC, Australia. 3Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia. 4Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Insights
Limited data support fluid bolus therapy for pediatric septic shock. More high-quality randomized controlled trials are needed to evaluate its effectiveness and optimal use in hospitalized children.
Area of Science:
- Pediatric critical care medicine
- Septic shock management
Background:
- Fluid bolus therapy is commonly used for pediatric septic shock.
- Evidence supporting its efficacy and optimal protocols is limited.
Purpose of the Study:
- To systematically review existing data on fluid bolus therapy in pediatric septic shock.
- To identify gaps in current research.
Main Methods:
- Systematic review of randomized and nonrandomized studies.
- Searched Medline, EMBASE, and Cochrane Central Register of Controlled Trials.
- Included studies on severe sepsis/septic shock, excluding neonatal and specific etiology studies.
Main Results:
- Analyzed 3 randomized controlled trials and 8 nonrandomized studies.
- Heterogeneity precluded meta-analysis.
- No significant physiological differences observed based on fluid bolus volume; no trials compared fluids with vasopressors.
Conclusions:
- Current evidence for fluid bolus therapy in pediatric septic shock is limited.
- Urgent need for prospective observational data and randomized controlled trials.
- Further research required, especially in resource-rich settings.
Objectives:
To review systematically data from randomized and nonrandomized studies of fluid bolus therapy in hospitalized children with septic shock.
Data Sources:
Medline, EMBASE, and Cochrane Central Register of Controlled Trials.
Study Selection:
We searched for randomized controlled studies of fluid bolus therapy in children with severe sepsis. We identified retrospective, prospective, and observational studies. We excluded studies of severe sepsis/septic shock due to a specific microbiological etiology, neonatal studies, and studies where advanced supportive therapies were unavailable.
Data Extraction:
Two authors screened articles for inclusion.
Data Synthesis:
We identified and analyzed three randomized controlled trials and eight nonrandomized studies. Heterogeneity precluded meta-analysis. Two single-center Indian studies and one Brazilian study assessed three different fluid bolus therapy regimens in small cohorts with different populations, physiological triggers, and physiological and clinical outcomes. No randomized controlled trials compared fluid bolus therapy with alternative interventions, such as vasopressors. The nonrandomized studies were heterogeneous in populations, methodology, and outcome measures. No observed physiological differences were identified based on volume of fluid bolus therapy.
Conclusions:
There are only limited data to support the use of fluid bolus therapy in hospitalized children. Prospective observational data and randomized controlled trials are urgently needed to evaluate this therapy in resource rich settings.
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