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A Study to Compare Ultrasound-guided and Clinically Guided Fluid Management in Children with Septic Shock
Ryan Sohail Kaiser1, Mihir Sarkar1, Sumantra Kumar Raut2
1Department of Pediatrics, Kolkata Medical College, Kolkata, West Bengal, India.
Insights
Ultrasound-guided fluid resuscitation significantly reduced fluid overload in children with septic shock compared to clinical guidance. This approach also decreased fluid administration and resuscitation time, improving patient outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Emergency Medicine
- Point-of-Care Ultrasound (POCUS)
Background:
- Septic shock in children necessitates careful fluid resuscitation to avoid complications like fluid overload.
- Clinical assessment alone may lead to suboptimal fluid management in pediatric septic shock.
- Evaluating novel resuscitation strategies is crucial for improving outcomes in critically ill children.
Observation:
- A randomized controlled trial compared ultrasound-guided versus clinically guided fluid boluses in children with septic shock.
- The study enrolled 56 children aged 1 month to 12 years in a tertiary care hospital.
- Fluid overload on day 3 was the primary outcome, with secondary outcomes including fluid balance and resuscitation time.
Findings:
- Ultrasound-guided fluid resuscitation resulted in a significantly lower incidence of fluid overload on day 3 (25% vs. 62%, p=0.012).
- The ultrasound group had a lower cumulative fluid balance percentage and received significantly less fluid volume per bolus.
- Resuscitation time was also significantly shorter in the ultrasound-guided group (13.4 vs. 20.5 hours, p=0.002).
Implications:
- Ultrasound guidance is a superior method for fluid resuscitation in pediatric septic shock, effectively preventing fluid overload.
- Integrating POCUS into fluid management protocols can optimize resuscitation and reduce associated complications.
- This evidence supports the broader adoption of ultrasound-guided fluid therapy in pediatric intensive care units.
Background:
To evaluate the role of ultrasound during initial fluid resuscitation along with clinical guidance in reducing the incidence of fluid overload on day 3 in children with septic shock.
Materials And Methods:
It was a prospective, parallel limb open-labeled randomized controlled superiority trial done in the PICU of a government-aided tertiary care hospital in Eastern India. Patient enrolment took place between June 2021 and March 2022. Fifty-six children aged between 1 month and 12 years, with proven or suspected septic shock, were randomized to receive either ultrasound-guided or clinically guided fluid boluses (1:1 ratio) and subsequently followed up for various outcomes. The primary outcome was frequency of fluid overload on day 3 of admission. The treatment group received ultrasound-guided fluid boluses along with the clinical guidance and the control group received the same but without ultrasound guidance upto 60 mL/kg of fluid boluses.
Results:
The frequency of fluid overload on day 3 of admission was significantly lower in the ultrasound group (25% vs 62%, p = 0.012) as was the median (IQR) cumulative fluid balance percentage on day 3 [6.5 (3.3-10.3) vs 11.3 (5.4-17.5), p = 0.02]. The amount of fluid bolus administered was also significantly lower by ultrasound [median 40 (30-50) vs 50 (40-80) mL/kg, p = 0.003]. Resuscitation time was shorter in the ultrasound group (13.4 ± 5.6 vs 20.5 ± 8 h, p = 0.002).
Conclusion:
Ultrasound-guided fluid boluses were found to be significantly better than clinically guided therapy, in preventing fluid overload and its associated complications in children with septic shock. These factors make ultrasound a potentially useful tool for resuscitation of children with septic shock in the PICU.
How To Cite This Article:
Kaiser RS, Sarkar M, Raut SK, Mahapatra MK, Uz Zaman MA, Roy O, et al. A Study to Compare Ultrasound-guided and Clinically Guided Fluid Management in Children with Septic Shock. Indian J Crit Care Med 2023;27(2):139-146.
