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Fluid Bolus Therapy in Pediatric Sepsis: Current Knowledge and Future Direction

Ben Gelbart1,2,3

  • 1Paediatric Intensive Care Unit Royal Children's Hospital, Melbourne, VIC, Australia.

Frontiers in Pediatrics
|November 10, 2018
PubMed

Insights

Fluid bolus therapy (FBT) is a first-line treatment for pediatric septic shock, but evidence supporting its use is limited. This review examines current knowledge and future directions for FBT in pediatric sepsis.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pediatric Infectious Diseases
  • Pediatric Resuscitation Science

Background:

  • Sepsis is a significant cause of child morbidity and mortality, with an 8% prevalence in pediatric intensive care units.
  • Fluid bolus therapy (FBT) has been a cornerstone of septic shock resuscitation for two decades, yet supporting evidence is limited.
  • Emerging evidence suggests potential harm from FBT, prompting re-evaluation and interest in fluid-restrictive strategies.

Purpose of the Study:

  • To review the current understanding of fluid bolus therapy in pediatric sepsis.
  • To explore the physiological and hemodynamic responses to FBT in children.
  • To identify knowledge gaps and future research directions for FBT in pediatric sepsis.

Main Methods:

  • Literature review of existing studies on fluid bolus therapy in pediatric sepsis.
  • Analysis of current evidence regarding the efficacy and safety of FBT.
  • Discussion of the complexities in studying FBT, including physiological responses and monitoring limitations.

Main Results:

  • The evidence base for current FBT guidelines is derived from limited data, including animal and case-control studies.
  • The physiological and hemodynamic effects of FBT in children are not well-characterized.
  • Assessing circulatory status in pediatric sepsis relies on non-specific clinical signs and limited monitoring.

Conclusions:

  • A deeper understanding of FBT's physiological impact and potential harms in pediatric sepsis is crucial.
  • Further research is warranted to optimize fluid management strategies in pediatric septic shock.
  • This review highlights the need for improved methodologies and targets for studying FBT in critically ill children.

Keywords:
fluid therapypediatricsepsisseptic shockvolume responsiveness

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