Fluid bolus therapy in pediatric sepsis: a narrative review

Area of Science:

• Pediatric critical care medicine
• Infectious diseases
• Resuscitation science

Background:

• Pediatric sepsis is a leading cause of mortality in children under five globally.
• Recent guidelines emphasize fluid bolus therapy as a cornerstone in managing pediatric septic shock and organ dysfunction.
• The optimal fluid choice for resuscitation, particularly balanced crystalloids, is debated due to limited evidence.

Purpose of the Study:

• To review the current evidence on fluid bolus therapy in pediatric sepsis.
• To discuss the role and efficacy of balanced crystalloids in pediatric sepsis resuscitation.
• To highlight the ongoing debate regarding fluid selection in pediatric sepsis management.

Main Methods:

• Literature review of current evidence on fluid resuscitation in pediatric sepsis.
• Analysis of Surviving Sepsis Campaign guidelines (2020) regarding pediatric sepsis management.
• Discussion of theoretical benefits and clinical data on balanced crystalloids versus other fluid options.

Main Results:

• Fluid bolus therapy is a critical component of pediatric sepsis management.
• Balanced crystalloids are proposed as potentially beneficial, but evidence in pediatrics is limited and debated.
• Adult data on fluid choice in sepsis are not consistently applicable to pediatric populations.

Conclusions:

• Further high-quality research is needed to establish the optimal fluid for pediatric sepsis resuscitation.
• The use of balanced crystalloids in pediatric sepsis requires more investigation to clarify their benefits and risks.
• Clinical practice regarding fluid selection in pediatric sepsis should consider the evolving evidence and ongoing expert discussion.