Long Elliot, Babl Franz, Dalziel Stuart, Dalton Sarah, Etheridge Carly, Duke Trevor
Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Emerg Med Australas. 2015 Jun;27(3):245-50. doi: 10.1111/1742-6723.12400. Epub 2015 Apr 28.
It is unclear whether emerging evidence for harm from aggressive fluid resuscitation for paediatric sepsis has altered clinical practice. We surveyed senior emergency physicians to see if their fluid resuscitation practices conformed to published clinical guidelines.
This is a cross-sectional, Internet-based survey of senior emergency medical staff in any of 12 Paediatric Research in Emergency Departments International Collaborative (PREDICT) Network centres in Australia and New Zealand.
There were 110 of 120 (92%) senior medical staff who responded. Ninety-eight per cent of respondents used 0.9% saline as their primary resuscitation fluid. Sixty-two per cent of respondents used 20 mL/kg fluid bolus for every bolus, 30% used 20 mL/kg for the first bolus and 10 mL/kg subsequently. Response to fluid bolus administration was based on clinical parameters in 92% of respondents (heart rate, BP, skin perfusion/mottling and central capillary refill), conscious state in 80% and venous lactate in 75%. Harm from fluid bolus administration was routinely monitored for by 81% of respondents. In those assessing for harm, clinical parameters were reported to be most commonly used (respiratory rate and effort in 60%, SpO2 in 55%, presence of crackles on lung auscultation in 50% and hepatomegaly in 42%). Invasive or ultrasound-based monitoring was used infrequently.
Paediatric sepsis is reported to be managed by senior emergency physicians largely according to published guidelines. At this time, evidence for potential harm from fluid bolus resuscitation has not altered practice.
积极的液体复苏对儿童脓毒症有害这一最新证据是否改变了临床实践尚不清楚。我们调查了资深急诊医师，以了解他们的液体复苏实践是否符合已发表的临床指南。
这是一项基于互联网的横断面调查，对象为澳大利亚和新西兰12个国际急诊儿科研究协作组（PREDICT）网络中心的资深急诊医护人员。
120名资深医护人员中有110名（92%）做出了回应。98%的受访者将0.9%的生理盐水作为主要复苏液体。62%的受访者每次推注液体的剂量为20 mL/kg，30%的受访者首次推注剂量为20 mL/kg，随后为10 mL/kg。92%的受访者根据临床参数（心率、血压、皮肤灌注/斑纹和中心毛细血管再充盈）判断推注液体的反应，80%根据意识状态，75%根据静脉血乳酸水平。81%的受访者常规监测推注液体的危害。在评估危害的受访者中，最常报告使用的临床参数为呼吸频率和努力程度（60%）、血氧饱和度（55%）、肺部听诊有啰音（50%）和肝肿大（42%）。很少使用侵入性或基于超声的监测。
据报告，资深急诊医师在很大程度上按照已发表的指南处理儿童脓毒症。目前，推注液体复苏潜在危害的证据尚未改变实践。
