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Intravenous Fluid Bolus Rates Associated with Outcomes in Pediatric Sepsis: A Multi-Center Analysis
Paul C Mullan1, Christopher M Pruitt2, Kelly A Levasseur3
1Department of Pediatrics, Division of Emergency Medicine, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, VA, USA.
Insights
Rapid intravenous fluid bolus administration rates in pediatric sepsis were linked to increased mortality and need for intubation. Further controlled trials are necessary to confirm these findings in pediatric sepsis management.
Area of Science:
- Pediatric critical care
- Emergency medicine
- Clinical pharmacology
Background:
- Current pediatric sepsis guidelines advocate for rapid intravenous fluid bolus administration rates (BAR).
- Emerging evidence suggests a potential association between rapid BAR and increased patient morbidity.
- The clinical implications of current fluid resuscitation strategies in pediatric sepsis require further investigation.
Purpose of the Study:
- To investigate the association between emergency department (ED) intravenous fluid (IVF) bolus administration rates (BAR) and clinical outcomes in pediatric sepsis.
- To analyze the relationship between ED IVF BAR and 30-day mortality, intubation, and non-invasive positive pressure ventilation (NIPPV) in pediatric sepsis patients.
Main Methods:
- Secondary post-hoc analysis of retrospective data from the Pediatric Septic Shock Collaborative (PSSC) database (19 hospitals).
- Inclusion criteria: Patients aged 2 months to 21 years with presumed septic shock and complete data on weight, antibiotics, bolus timing, and volumes.
- Outcomes assessed: 30-day mortality, intubation, and NIPPV using unadjusted and adjusted logistic regression.
Main Results:
- The study included 3969 pediatric sepsis patients with a median ED fluid volume of 40.2 mL/kg and a median BAR of 25.7 mL/kg/hr.
- Increased BAR was significantly associated with higher adjusted odds of 30-day mortality (aOR=1.11), intubation (aOR=1.25), and NIPPV (aOR=1.20) for each 20 mL/kg/hr increment.
- 1.9% of patients died, 3.8% required intubation, and 5.9% received NIPPV.
Conclusions:
- Faster ED IVF bolus administration rates in pediatric sepsis patients were associated with increased adjusted odds of mortality, intubation, and NIPPV.
- These findings suggest a potential risk associated with rapid fluid resuscitation in pediatric sepsis.
- Controlled trials are warranted to confirm these associations and guide optimal fluid resuscitation strategies in pediatric sepsis.
Purpose:
Pediatric sepsis guidelines recommend rapid intravenous fluid (IVF) bolus administration rates (BAR). Recent sepsis studies suggest that rapid BAR may be associated with increased morbidity. We aimed to describe the association between emergency department (ED) IVF BAR and clinical outcomes in pediatric sepsis.
Patients And Methods:
Secondary post-hoc analysis of retrospective cohort data from 19 hospitals in the Pediatric Septic Shock Collaborative (PSSC) database. Patients with presumed septic shock were defined by severe sepsis/septic shock diagnostic codes, receipt of septic shock therapies, or floor-to-ICU transfers within 12 hours from ED admission for septic shock. Patients (2 months-21 years) with complete data on weight, antibiotic receipt, bolus timing, and bolus volumes were included. The primary outcome was 30-day mortality. Associations between BAR and mortality and secondary (intubation or non-invasive positive pressure ventilation = NIPPV) outcomes were assessed using unadjusted and adjusted logistic regression.
Results:
The PSSC database included 6731 patients; 3969 met inclusion and received a median ED volume of 40.2 mL/kg. Seventy-six (1.9%) patients died, 151 (3.8%) were intubated, and 235 (5.9%) had NIPPV administered. The median BAR was 25.7 mL/kg/hr. For each 20 mL/kg/hr increase in BAR, the adjusted odds ratio (aOR) for 30-day mortality [aOR = 1.11 (95% CI 1.01, 1.23)], intubation [aOR = 1.25 (95% CI 1.09, 1.44)], and NIPPV [aOR = 1.20 (95% CI 1.05, 1.38)] significantly increased.
Conclusion:
Faster ED IVF bolus administration rates in this pediatric sepsis database were associated with higher adjusted odds of death, intubation and NIPPV. Controlled trials are needed to determine if these associations are replicable.
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