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Area of Science:

  • Pediatric Emergency Medicine
  • Critical Care
  • Pediatric Sepsis Research

Background:

  • Early fluid resuscitation is crucial for pediatric septic shock management.
  • The optimal initial intravenous fluid volume in pediatric septic shock remains a subject of investigation.
  • Understanding fluid volume effects on mortality is vital for clinical practice guidelines.

Purpose of the Study:

  • To investigate the association between receiving ≥30 mL/kg of intravenous fluids within the first hour of emergency department (ED) arrival and sepsis-attributable mortality in children with hypotensive septic shock.
  • To secondarily evaluate this association in children with suspected sepsis, irrespective of blood pressure.

Main Methods:

  • Retrospective cohort study involving 57 EDs within a quality improvement collaborative.
  • Propensity-score matching was used for patients with hypotensive septic shock receiving their first fluid bolus within 1 hour of ED arrival.
  • Sepsis-attributable mortality was compared between groups receiving ≥30 mL/kg versus <30 mL/kg of fluid in the first hour.

Main Results:

  • In propensity-matched children with hypotensive septic shock, 30-day mortality was 4.3% for those receiving ≥30 mL/kg (n=602) versus 4.2% for those receiving <30 mL/kg (n=602) (OR 1.04; 95% CI 0.59-1.83).
  • Among all children with suspected sepsis, mortality was 3.0% for those receiving ≥30 mL/kg versus 2.0% for those receiving <30 mL/kg (OR 1.52; 95% CI 0.95-2.44).

Conclusions:

  • In children with hypotensive septic shock receiving timely initial fluid boluses, administering ≥30 mL/kg of intravenous fluids in the first hour was not associated with increased sepsis-attributable mortality.
  • The findings suggest that the standard fluid resuscitation volume in the initial hour for pediatric septic shock does not adversely affect mortality.
  • Further research may explore nuances in fluid management for specific pediatric sepsis presentations.