Intravenous Fluid Bolus Rates Associated with Outcomes in Pediatric Sepsis: A Multi-Center Analysis.

Authors

Paul C Mullan
Christopher M Pruitt
Kelly A. Levasseur, Beaumont Health
Charles G Macias
Raina Paul
Holly Depinet
Anh Thy H Nguyen
Elliot Melendez

Document Type

Article

Publication Date

7-28-2022

Publication Title

Open Access Emergency Medicine

Abstract

Purpose: Pediatric sepsis guidelines recommend rapid intravenous fluid (IVF) bolus administration rates (BAR). Recent sepsis studies suggest that rapid BAR may be associated with increased morbidity. We aimed to describe the association between emergency department (ED) IVF BAR and clinical outcomes in pediatric sepsis.

Patients and Methods: Secondary post-hoc analysis of retrospective cohort data from 19 hospitals in the Pediatric Septic Shock Collaborative (PSSC) database. Patients with presumed septic shock were defined by severe sepsis/septic shock diagnostic codes, receipt of septic shock therapies, or floor-to-ICU transfers within 12 hours from ED admission for septic shock. Patients (2 months-21 years) with complete data on weight, antibiotic receipt, bolus timing, and bolus volumes were included. The primary outcome was 30-day mortality. Associations between BAR and mortality and secondary (intubation or non-invasive positive pressure ventilation = NIPPV) outcomes were assessed using unadjusted and adjusted logistic regression.

Results: The PSSC database included 6731 patients; 3969 met inclusion and received a median ED volume of 40.2 mL/kg. Seventy-six (1.9%) patients died, 151 (3.8%) were intubated, and 235 (5.9%) had NIPPV administered. The median BAR was 25.7 mL/kg/hr. For each 20 mL/kg/hr increase in BAR, the adjusted odds ratio (aOR) for 30-day mortality [aOR = 1.11 (95% CI 1.01, 1.23)], intubation [aOR = 1.25 (95% CI 1.09, 1.44)], and NIPPV [aOR = 1.20 (95% CI 1.05, 1.38)] significantly increased.

Conclusion: Faster ED IVF bolus administration rates in this pediatric sepsis database were associated with higher adjusted odds of death, intubation and NIPPV. Controlled trials are needed to determine if these associations are replicable.

Volume

14

First Page

375

Last Page

384

Recommended Citation

Mullan PC, Pruitt CM, Levasseur KA, Macias CG, Paul R, Depinet H, et al Intravenous fluid bolus rates associated with outcomes in pediatric sepsis: a multi-center analysis. Open Access Emerg Med. 2022 Jul 28;14:375-384. doi: 10.2147/OAEM.S368442. PMID: 35924031.

DOI

10.2147/OAEM.S368442

ISSN

1179-1500

PubMed ID

35924031