Fluid Bolus Over 15-20 Versus 5-10 Minutes Each in the First Hour of Resuscitation in Children With Septic Shock : A Randomized Controlled Trial
OBJECTIVES: To compare the effect of administration of 40-60 mL/kg of fluids as fluid boluses in aliquots of 20 mL/kg each over 15-20 minutes with that over 5-10 minutes each on the composite outcome of need for mechanical ventilation and/or impaired oxygenation-increase in oxygenation index by 5 from baseline in the initial 6 and 24 hours in children with septic shock.
DESIGN: Randomized controlled trial.
SETTING: Pediatric emergency and ICU of a tertiary care institute.
PATIENTS: Children (< 18 yr old) with septic shock.
INTERVENTIONS: We randomly assigned participants to 15-20 minutes bolus (study group) or 5-10 minutes bolus groups (control group).
MEASUREMENTS AND MAIN RESULTS: We assessed the composite outcomes in the initial 6 and 24 hours after fluid resuscitation in both groups. We performed logistic regression to evaluate factors associated with need for ventilation in the first hour. Data were analyzed using Stata 11.5. Of the 96 children, 45 were randomly assigned to "15-20 minutes group" and 51 to "5-10 minutes group." Key baseline characteristics were not different between the groups. When compared with 5-10 minutes group, fewer children in 15-20 minutes group needed mechanical ventilation or had an increase in oxygenation index in the first 6 hours (36% vs 57%; relative risk, 0.62; 95% CI, 0.39-0.99) and 24 hours (43% vs 68%; relative risk, 0.63; 95% CI, 0.42-0.93) after fluid resuscitation. We did not find any difference in secondary outcomes such as death (1.2; 0.70-2.03), length of stay (mean difference: 0.52; -1.72 to 2.7), or resolution of shock (0.98; 0.63-1.53).
CONCLUSION: Children receiving fluid boluses over 5-10 minutes each had a higher risk of intubation than those receiving boluses over 15-20 minutes each. Notwithstanding the lack of difference in risk of mortality and the possibility that a lower threshold of intubation and mechanical ventilation was used in the presence of fluid overload, our results raise concerns on the current recommendation of administering boluses over 5-10 minutes each in children with septic shock.
| Errataetall: |
CommentIn: Pediatr Crit Care Med. 2017 Oct;18(10):995-997. - PMID 28976467 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2017 |
|---|---|
| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:18 |
|---|---|
| Enthalten in: |
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies - 18(2017), 10 vom: 01. Okt., Seite e435-e445 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Sankar, Jhuma [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 03.05.2018 Date Revised 11.03.2022 published: Print CommentIn: Pediatr Crit Care Med. 2017 Oct;18(10):995-997. - PMID 28976467 Citation Status MEDLINE |
|---|
| doi: |
10.1097/PCC.0000000000001269 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM274510758 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM274510758 | ||
| 003 | DE-627 | ||
| 005 | 20231225003638.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2017 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1097/PCC.0000000000001269 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0915.xml |
| 035 | |a (DE-627)NLM274510758 | ||
| 035 | |a (NLM)28777139 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Sankar, Jhuma |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Fluid Bolus Over 15-20 Versus 5-10 Minutes Each in the First Hour of Resuscitation in Children With Septic Shock |b A Randomized Controlled Trial |
| 264 | 1 | |c 2017 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 03.05.2018 | ||
| 500 | |a Date Revised 11.03.2022 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: Pediatr Crit Care Med. 2017 Oct;18(10):995-997. - PMID 28976467 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVES: To compare the effect of administration of 40-60 mL/kg of fluids as fluid boluses in aliquots of 20 mL/kg each over 15-20 minutes with that over 5-10 minutes each on the composite outcome of need for mechanical ventilation and/or impaired oxygenation-increase in oxygenation index by 5 from baseline in the initial 6 and 24 hours in children with septic shock | ||
| 520 | |a DESIGN: Randomized controlled trial | ||
| 520 | |a SETTING: Pediatric emergency and ICU of a tertiary care institute | ||
| 520 | |a PATIENTS: Children (< 18 yr old) with septic shock | ||
| 520 | |a INTERVENTIONS: We randomly assigned participants to 15-20 minutes bolus (study group) or 5-10 minutes bolus groups (control group) | ||
| 520 | |a MEASUREMENTS AND MAIN RESULTS: We assessed the composite outcomes in the initial 6 and 24 hours after fluid resuscitation in both groups. We performed logistic regression to evaluate factors associated with need for ventilation in the first hour. Data were analyzed using Stata 11.5. Of the 96 children, 45 were randomly assigned to "15-20 minutes group" and 51 to "5-10 minutes group." Key baseline characteristics were not different between the groups. When compared with 5-10 minutes group, fewer children in 15-20 minutes group needed mechanical ventilation or had an increase in oxygenation index in the first 6 hours (36% vs 57%; relative risk, 0.62; 95% CI, 0.39-0.99) and 24 hours (43% vs 68%; relative risk, 0.63; 95% CI, 0.42-0.93) after fluid resuscitation. We did not find any difference in secondary outcomes such as death (1.2; 0.70-2.03), length of stay (mean difference: 0.52; -1.72 to 2.7), or resolution of shock (0.98; 0.63-1.53) | ||
| 520 | |a CONCLUSION: Children receiving fluid boluses over 5-10 minutes each had a higher risk of intubation than those receiving boluses over 15-20 minutes each. Notwithstanding the lack of difference in risk of mortality and the possibility that a lower threshold of intubation and mechanical ventilation was used in the presence of fluid overload, our results raise concerns on the current recommendation of administering boluses over 5-10 minutes each in children with septic shock | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 700 | 1 | |a Ismail, Javed |e verfasserin |4 aut | |
| 700 | 1 | |a Sankar, M Jeeva |e verfasserin |4 aut | |
| 700 | 1 | |a C P, Suresh |e verfasserin |4 aut | |
| 700 | 1 | |a Meena, Rameshwar S |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies |d 2000 |g 18(2017), 10 vom: 01. Okt., Seite e435-e445 |w (DE-627)NLM124299717 |x 1529-7535 |7 nnns |
| 773 | 1 | 8 | |g volume:18 |g year:2017 |g number:10 |g day:01 |g month:10 |g pages:e435-e445 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1097/PCC.0000000000001269 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 18 |j 2017 |e 10 |b 01 |c 10 |h e435-e445 | ||