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Childhood Mortality After Fluid Bolus With Septic or Severe Infection Shock: A Systematic Review and Meta-Analysis
Jing Yue1, Ronghao Zheng2, Huiping Wei1
1Emergency Department, Maternity And Child Health Care Hospital Hubei, Women And Children's Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
In pediatric septic shock, withholding fluid bolus therapy may reduce mortality, particularly in malaria cases. Further research with larger sample sizes is recommended for definitive conclusions.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Diseases
- Resuscitation Science
Background:
- The efficacy of fluid bolus administration in reducing mortality among pediatric patients with septic or severe infection shock remains a subject of ongoing debate.
- Existing evidence is inconclusive, necessitating a comprehensive analysis of available data.
Purpose of the Study:
- To systematically review and conduct a meta-analysis investigating mortality rates in pediatric patients with septic or severe infection shock following fluid bolus administration.
- To evaluate the impact of fluid bolus therapy on short-term (48-hour) and long-term (4-week) mortality.
Main Methods:
- A systematic electronic search of major databases (PubMed, MEDLINE, Cochrane Library, EMBASE) was performed for studies published up to March 30, 2020.
- Included studies comprised 9,321 pediatric patients diagnosed with severe sepsis or septic shock.
- Quality assessment of the included studies was conducted.
Main Results:
- Analysis of 17 studies reporting 48-hour mortality revealed a decreased mortality rate in the no-bolus group compared to the bolus group (Risk Ratio [RR] = 0.74; 95% Confidence Interval [CI] = 0.62-0.88).
- This finding was particularly pronounced in malaria shock cases and consistent for both colloids and crystalloids.
- Analysis of two studies reporting 4-week mortality also indicated a protective effect of the no-bolus approach (RR = 0.71; 95% CI = 0.57-0.88).
Conclusions:
- Withholding fluid bolus therapy appears to decrease mortality at 48 hours and 4 weeks in pediatric patients with septic or severe infection shock, especially in malaria-associated cases.
- The findings suggest a potential re-evaluation of current fluid resuscitation guidelines in this vulnerable population.
- Further large-scale meta-analyses with extended follow-up periods are warranted to solidify these conclusions.
Background:
A considerable debate on whether fluid bolus could decrease childhood mortality in pediatric patients with septic or severe infection shock is still unresolved. A systematic review and meta-analysis was conducted to investigate the mortality rates after fluid bolus among children with septic or severe infection shock.
Methods:
A systematic electronic search of PubMed, MEDLINE, Cochrane Library, and EMBASE databases was conducted to identify relevant published studies till March 30, 2020.
Results:
A total of 19 studies with 9,321 severe sepsis or septic shock pediatric patients were included and exhibited an acceptable quality. Of the 17 studies that reported mortality at 48 h, no bolus group decreased the mortality rate when compared with bolus group with a risk ratio (RR) of 0.74 [95% confidence interval (CI) = 0.62-0.88, P < 0.01], and showed no heterogeneity (I2 = 0%). Similar results were observed on colloids and crystalloids solution in malaria shock cases with a RR of 0.79 (95% CI = 0.62-1.02). For the subgroup of general shock patients, no significant difference was shown with an RR of 0.79 (95% CI = 0.62-1.02, P = 0.07) and no significant heterogeneity (I2 = 0%). Two studies reported mortality at week 4 and pooled results indicated that no bolus group was protective against mortality when compared with bolus group with RR of 0.71 (95% CI = 0.57-0.88, I2 = 0%).
Conclusion:
For the mortality at 48 h, the no bolus group showed decreased mortality when compared with the bolus group, especially in the malaria group. Similar results were found in the colloids and crystalloids solution in patients with malaria shock. Meta-analysis studies with long-term follow-up period and larger sample size are warranted to address the conclusion in the future.
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