Abstract
BackgroundGoal-directed therapy guidelines for pediatric septic shock resuscitation recommend fluid delivery at speeds in excess of that possible through use of regular fluid infusion pumps. In our experience, syringes are commonly used by health care providers (HCPs) to achieve rapid fluid resuscitation in a pediatric fluid resuscitation scenario. At present, it is unclear which syringe size health care providers should use when performing fluid resuscitation to achieve maximal fluid resuscitation efficiency. The objective of this study was therefore to determine if an optimal syringe size exists for conducting manual pediatric fluid resuscitation.MethodsThis 48-participant parallel group randomized controlled trial included 4 study arms (10, 20, 30, 60 mL syringe size groups). Eligible participants were HCPs from McMaster Children’s Hospital, Hamilton, Canada blinded to the purpose of the trial. Consenting participants were randomized using a third party technique. Following a standardization procedure, participants administered 900 mL (60 mL/kg) of isotonic saline to a simulated 15 kg child using prefilled provided syringes of the allocated size in rapid sequence. Primary outcome was total time to administer the 900 mL and this data was collected through video review by two blinded outcome assessors. Sample size was predetermined based upon a primary outcome analysis using one-way ANOVA.Results12 participants were randomized to each group (n=48) and all completed trial protocol to analysis. Analysis was conducted according to intention to treat principles. A significant difference in fluid resuscitation time (in seconds) was found between syringe size group means: 10 mL, 563s [95% CI 521; 606]; 20 mL, 506s [95% CI 64; 548]; 30 mL, 454s [95% CI 412; 596]; 60 mL, 455s [95% CI 413; 497] (p<0.001).ConclusionsThe syringe size used when performing manual pediatric fluid resuscitation has a significant impact on fluid resuscitation speed, in a setting where fluid filled syringes are continuously available. Greatest efficiency was achieved with 30 or 60 mL syringes.Trial registrationClinicalTrials.gov, NCT01494116
Highlights
Goal-directed therapy guidelines for pediatric septic shock resuscitation recommend fluid delivery at speeds in excess of that possible through use of regular fluid infusion pumps
Clear pragmatic recommendations for health care providers (HCPs) as to how to achieve rapid fluid resuscitation are lacking in current guidelines
Options for rapid fluid resuscitation include rapid infuser devices and pressure bag support [6,7,8]. While these modalities are available for use in pediatric resuscitation, in our experience, syringes are most commonly used for this purpose, likely due to their relative availability and health care providers’ comfort using them
Summary
Goal-directed therapy guidelines for pediatric septic shock resuscitation recommend fluid delivery at speeds in excess of that possible through use of regular fluid infusion pumps. Syringes are commonly used by health care providers (HCPs) to achieve rapid fluid resuscitation in a pediatric fluid resuscitation scenario. The American College of Critical Care Medicine (ACCM) guidelines for early goal-directed pediatric septic shock management recommend to, “Push boluses of 20 cc/kg isotonic saline or colloid up to & over 60 cc/kg until perfusion improves or unless rales or hepatomegaly develop” [4]. Options for rapid fluid resuscitation include rapid infuser devices and pressure bag support [6,7,8]. While these modalities are available for use in pediatric resuscitation, in our experience, syringes are most commonly used for this purpose, likely due to their relative availability and health care providers’ comfort using them. In this study only 58% of children resuscitated in the pressure bag and 68% in the syringe group met the ACCM benchmarks
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