ABSTRACT 113

Abstract

Background and aims: Initial aggressive fluid resuscitation is of proven benefit in septic shock. Optimal post resuscitation fluid management is not known. Aims: To compare restrictive vs. conventional fluid regimes in children with septic shock after initial resuscitation admitted to PICU over 12 months. Methods: This prospective randomized trial was approved by IRB. After getting informed consent; 101 children aged from 3 to 144 months were enrolled. After initial resuscitation, patients were randomly assigned to receive restrictive (A) [Fluid input based on calculated fluid overload] or conventional (B) fluid [80% of maintenance]. The primary outcome was length of PICU stay. Secondary outcomes included:28 days mortality, organ failure free days, ventilator-free days, and incidence of AKI. Data was analyzed on an ‘intention-to-treat’ basis. Intergroup differences were tested with Student t test, Mann Whitney-U, chi-square test and ANOVA for repeated measures as appropriate. Time to event was analyzed with Kaplan-Meier method and Mantel-Cox log rank test. Results: The mean (±SD) cumulative fluid balance at the end of study protocol [10th day] was –42.6 ± 82.6ml/lg (Group A) and 339 ± 117 ml/kg (Group B) (P<0.001). Group A had significantly shorter stay [7.1 ± 5.5 vs.10.3 ± 6.5 days; p=0.008], more ventilation free days [15.8 ± 10.8 vs.12.1 ± 9.4 days; P=0.14], improved OI and Pplateau, higher proportion of patients recovering from organ failure [92.5% vs.75%; p=0.005], and early recovery from septic shock [92.5 ± 68.8vs.123 ± 87 hours; p=0.05]. However mortality was similar [18.5vs.23.4%; p=0.54]. Conclusions: In children with septic shock a restrictive fluid management strategy in post resuscitation phase shortened the length of ICU stay, improved lung function and shortened ventilation without aggravating the hemodynamic instability.