G303(P) Practical recommendations for fluid resuscitation in paediatric septic shock

Abstract

Aims The management of severe sepsis and septic shock in children is complex and time critical and requires prompt recognition and secondly early administration of antibiotics and fluid resuscitation. The American College of Critical Care Medicine- Paediatric Advanced Life Support (ACCM-APLS 2007) Clinical Guideline for Haemodynamic Support of Neonates and Children with Septic Shock states that within 60 min one should be able to fluid resuscitate up to 60 ml/kg and if needed start inotropes to restore circulation. Therefore the research question we asked is ‘What is the recommended minimal gauge cannula for fluid resuscitation in each patient group to meet the first hour goals set by the American College of Critical Care Medicine (ACCM) for Paediatric Septic Shock? Method The study compared the total time taken to administer 60 ml/kg of fluid through different gauge cannula in the four patient groups using a pressurised delivery system. The four patient groups tested had a working weight of; 4 kg, 12 kg, 25 kg and 50 kg. The study was conducted in a non-clinical setting using a model simulating a child in septic shock. Under controlled conditions, one volunteer administered the 60 ml/kg volume in aliquots of 20 ml/kg to the simulated patient. The primary outcome was the total time taken to administer 60 ml/kg of 0.9% saline including time for preparation and re-assessment and secondary outcomes analysed were the flow rate (ml/min), average and fastest time to administer a 20 ml/kg bolus and the time taken to bolus with and without a cannula connector. Results To achieve the ACCM-PALS first hour goal for rapid fluid resuscitation in Paediatric Septic Shock one should aim to use the following recommended minimum size and brand of cannula per patient group as per the table below: Discussion This study provides practical recommendations for time-critical fluid resuscitation in sepsis and should lead to further research in the clinical setting. It should also support future iterations of Paediatric Resuscitation Guidelines regarding the optimal Paediatric fluid resuscitation technique.