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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Epidemiology and effects of fluid bolus administration in the paediatric emergency department
Tom Solan1, David J Stephens2, Amanda Williams1,3,4
1Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Fluid bolus therapy (FBT) is common in pediatric emergency departments, primarily for dehydration. This study analyzed FBT use, revealing common indications and effects like reduced heart rate and blood pressure.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Pharmacology
- Critical Care Medicine
Background:
- Fluid bolus therapy (FBT) is a cornerstone of acute circulatory support in various medical conditions.
- The epidemiological data regarding FBT use in pediatric emergency departments (EDs) is not well-established.
- Understanding FBT patterns is crucial for optimizing patient care in pediatric acute settings.
Purpose of the Study:
- To investigate the indications for fluid bolus therapy in a pediatric emergency department.
- To analyze the patterns of fluid bolus administration, including volume and fluid type.
- To assess the short-term physiological effects of fluid bolus therapy in pediatric patients.
Main Methods:
- A retrospective observational study was conducted using electronic medical record data from a large pediatric ED.
- Data from all patients receiving intravenous fluid boluses in 2018 were extracted.
- Demographics, indications, fluid volumes, fluid content, and subsequent vital sign and biochemical changes were analyzed.
Main Results:
- 1,539 fluid boluses were administered to 1,343 children, representing 1.5% of the ED census.
- Common indications included vomiting/diarrhea (23%), acute febrile illness (11%), pneumonia, and sepsis (10% each).
- Fluid bolus therapy was associated with significant reductions in heart rate, mean blood pressure, and venous lactate levels.
Conclusions:
- Fluid bolus therapy is a frequently utilized intervention in pediatric emergency departments, predominantly for managing dehydration.
- Observed variability in the indications, dosing strategies, and treatment effects necessitates further research.
- Further exploration is warranted to refine FBT protocols and enhance outcomes in pediatric emergency care.
Objective:
Fluid bolus therapy (FBT) is recommended as the initial form of acute circulatory support for many disease processes. The epidemiology of its use in the ED is unknown. The aim of this study was to assess indications, use patterns and short-term effects of FBT in a paediatric ED.
Methods:
Retrospective observational study in the ED of the Royal Children's Hospital, Melbourne, Australia (annual census >90 000) using hospital electronic medical record data for all patients who received an i.v. fluid bolus in the ED over the calendar year 2018 were included in the study. We extracted demographics, indications, volume, content of FBT as well as subsequent vital sign and biochemical changes.
Results:
One thousand five hundred and thirty-nine fluid boluses were administered to 1343/90 000 children (1.5%), 1185 received 1, 123 received 2, 32 received 3, and 3 received 4 boluses. Fluid bolus volume of 10 mL/kg was used in 45.3%, 20 mL/kg in 35.7%, 500 mL in 6.4% and 1000 mL in 7.1%. The fluid content was 0.9% saline in 99.9% of cases. The most common indications for FBT were: vomiting/diarrhoea (23%), acute febrile illness (11%) and pneumonia or sepsis (10% each). FBT was associated with a reduction in median heart rate by 6 beats per minute (P < 0.01), reduction in mean blood pressure by 3 mmHg (P < 0.01), and reduction in venous lactate by 0.2 mmol/L (P < 0.01).
Conclusions:
Fluid bolus therapy is a commonly used intervention in the paediatric ED, most often for dehydration. Variability in indications, dose and effects of FBT warrant further exploration.
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