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Published on: April 11, 2012
Cardiac Index Changes With Fluid Bolus Therapy in Children With Sepsis-An Observational Study
Elliot Long1,2,3, Franz E Babl1,2,3, Ed Oakley1,2,3
1Department of Emergency Medicine, The Royal Children's Hospital, Parkville, VIC, Australia.
Insights
Fluid bolus therapy in children with sepsis provides a temporary boost to cardiac index. However, fluid responsiveness is inconsistent and not sustained, limiting its effectiveness in improving cardiac function.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular physiology
- Sepsis research
Background:
- Fluid bolus therapy is the standard initial treatment for acute circulatory failure in sepsis.
- The impact of fluid bolus therapy on cardiac index in pediatric sepsis remains unclear.
Purpose of the Study:
- To investigate the effect of fluid bolus therapy on cardiac index in children diagnosed with sepsis.
- To determine the duration and variability of fluid responsiveness in this patient population.
Main Methods:
- A prospective observational cohort study was conducted involving children with sepsis and circulatory failure.
- Transthoracic echocardiography was used to measure cardiac index before and after fluid bolus administration (at 5 and 60 minutes).
- Fluid responsiveness was defined as a >10% increase in cardiac index at 5 minutes post-bolus.
Main Results:
- A median increase of 18.0% in cardiac index was observed 5 minutes after fluid bolus therapy.
- This increase was transient, with a median decrease of -6.0% at 60 minutes.
- Only 14% of fluid-responsive children maintained the increased cardiac index at 60 minutes.
Conclusions:
- Fluid bolus therapy in pediatric sepsis leads to a short-lived improvement in cardiac index.
- Fluid responsiveness is highly variable and generally not sustained beyond 60 minutes.
- The study highlights limitations in using fluid bolus therapy to achieve sustained hemodynamic improvement in pediatric sepsis.
Objectives:
Fluid bolus therapy is the initial recommended treatment for acute circulatory failure in sepsis, yet it is unknown whether this has the intended effect of increasing cardiac index. We aimed to describe the effect of fluid bolus therapy on cardiac index in children with sepsis.
Design:
A prospective observational cohort study.
Setting:
The Emergency Department of The Royal Children's Hospital, Melbourne, VIC, Australia.
Patients:
A convenience sample of children meeting international consensus criteria for sepsis with acute circulatory failure.
Intervention:
Treating clinician decision to administer fluid bolus therapy.
Measurements And Main Results:
Transthoracic echocardiography was recorded immediately before, 5 minutes after, and 60 minutes after fluid bolus therapy. Cardiac index was calculated by a pediatric cardiologist blinded to the timing of the echocardiogram. Cardiac index was calculated for 49 fluid boluses in 41 children. The median change in cardiac index 5 minutes after a fluid bolus therapy was +18.0% (interquartile range, 8.6-28.1%) and after 60 minutes was -6.0% (interquartile range, -15.2% to 3.0%) relative to baseline. Thirty-one of 49 fluid boluses (63%) resulted in an increase in cardiac index of greater than 10% at 5 minutes, and these participants were considered fluid responsive. This was sustained in four of 31 (14%) at 60 minutes. No association between change in cardiac index at 5 or 60 minutes and age, baseline mean arterial blood pressure, fluid bolus volume, and prior volume of fluid bolus therapy was found on linear regression.
Conclusions:
Fluid bolus therapy for pediatric sepsis is associated with a transient increase in cardiac index. Fluid responsiveness is variable and, when present, not sustained. The efficacy of fluid bolus therapy for achieving a sustained increase in cardiac index in children with sepsis is limited.
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