Rapid Fluid Resuscitation in Pediatrics: Testing the American College of Critical Care Medicine Guideline

Study objective The 2002 American College of Critical Care Medicine (ACCM) guidelines for the resuscitation of pediatric septic shock suggest that 20 mL/kg of bolus intravenous fluid be given within 5 minutes. Of 3 commonly used, inexpensive methods of fluid delivery, we hypothesized that only use o...

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Bibliographic Details
Published in:Annals of emergency medicine 2007-11, Vol.50 (5), p.601-607
Main Authors: Stoner, Michael J., MD, Goodman, Deborah G., RN, Cohen, Daniel M., MD, Fernandez, Soledad A., PhD, Hall, Mark W., MD
Format: Article
Language:English
Subjects:
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Child
Clinical death. Palliative care. Organ gift and preservation
Critical Care - methods
Emergency
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Emergency Service, Hospital
Female
Fluid Therapy - methods
Guideline Adherence
Humans
Intensive care medicine
Male
Medical sciences
Pediatrics
Resuscitation - methods
Shock, Septic - therapy
Societies, Medical
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Summary:Study objective The 2002 American College of Critical Care Medicine (ACCM) guidelines for the resuscitation of pediatric septic shock suggest that 20 mL/kg of bolus intravenous fluid be given within 5 minutes. Of 3 commonly used, inexpensive methods of fluid delivery, we hypothesized that only use of a manual push-pull system will permit guideline adherence. Methods This prospective, interventional study was open to children in the Columbus Children’s Hospital Emergency Department who were ordered a 20 mL/kg nonemergent fluid bolus by their treating physician. Subjects were randomized to receive the fluid for 5 minutes by a pressure bag maintained at 300 mm Hg, by a manual push-pull system, or by gravity. Volume of fluid delivered, absolute rates of fluid delivery, and adherence to the ACCM guideline were recorded. Statistical analysis was done with both parametric and nonparametric methods. Results Sixty children were enrolled, with 57 included in data analysis. Median volumes of fluid delivered in the study period were 20.9 mL/kg (pressure bag), 20.2 mL/kg (push-pull), and 6.2 mL/kg (gravity) ( P
ISSN:0196-0644
1097-6760
DOI:10.1016/j.annemergmed.2007.06.482