Early Fluid Resuscitation in Septic Shock
Matthew G. Gartland
Brian M. Cummings
Role of Early Fluid Resuscitation in Pediatric Septic Shock
Carcillo JA, Davis AL, Zaritsky A. JAMA. 1991;266(9):1242–1245
Background
The management of septic shock in children is challenging as patients can exhibit signs of hypovolemic, cardiogenic, and distributive shock. Treatment of septic shock with volume resuscitation may improve oxygen delivery and support cardiac output but can also result in cardiogenic or noncardiogenic pulmonary edema, now known as acute respiratory distress syndrome (ARDS). This small study performed over 20 years ago was the first to examine the role of aggressive volume resuscitation in children with septic shock.
Objectives
To assess the impact of early aggressive fluid management on survival and complications in pediatric septic shock.
Methods
Prospective, nonrandomized cohort study at a single US center from 1982 to 1989.
Patients
34 children ages 1 month to 16 years with shock (blood pressure <2 standard deviations below mean for age), poor perfusion, and positive blood or tissue culture who had placement of a pulmonary artery catheter within 6 hours of presentation. Select exclusion criteria: none.
Intervention
Patients were stratified into 3 groups based on the volume of crystalloid fluid received within the first hour of presentation to the emergency department: <20 mL/kg (group 1), 20 to 40 mL/kg (group 2), and >40 mL/kg (group 3). Volume status was reassessed at 6 hours.
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