Mullan Paul C, Pruitt Christopher M, Levasseur Kelly A, Macias Charles G, Paul Raina, Depinet Holly, Nguyen Anh Thy H, Melendez Elliot
Department of Pediatrics, Division of Emergency Medicine, Eastern Virginia Medical School, Children's Hospital of the King's Daughters, Norfolk, VA, USA.
Department of Pediatrics, Division of Pediatric Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA.
Open Access Emerg Med. 2022 Jul 28;14:375-384. doi: 10.2147/OAEM.S368442. eCollection 2022.
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.
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.
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.
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.
儿科脓毒症指南推荐快速静脉输液（IVF）推注速率（BAR）。近期的脓毒症研究表明，快速BAR可能与发病率增加有关。我们旨在描述急诊科（ED）IVF BAR与儿科脓毒症临床结局之间的关联。
对儿科脓毒症休克协作组（PSSC）数据库中19家医院的回顾性队列数据进行二次事后分析。疑似脓毒症休克的患者通过严重脓毒症/脓毒症休克诊断编码、接受脓毒症休克治疗或在因脓毒症休克入住急诊科后12小时内从病房转入重症监护病房来定义。纳入体重、抗生素使用、推注时间和推注量数据完整的患者（2个月至21岁）。主要结局是30天死亡率。使用未调整和调整后的逻辑回归评估BAR与死亡率以及次要结局（插管或无创正压通气=NIPPV）之间的关联。
PSSC数据库包括6731例患者；3969例符合纳入标准，急诊科静脉输液量中位数为40.2 mL/kg。76例（1.9%）患者死亡，151例（3.8%）接受插管，235例（5.9%）接受NIPPV治疗。BAR中位数为25.7 mL/kg/小时。BAR每增加20 mL/kg/小时，30天死亡率的调整优势比（aOR）[aOR = 1.11（95%CI 1.01，1.23）]、插管[aOR = 1.25（95%CI 1.09，1.44）]和NIPPV[aOR = 1.20（95%CI 1.05，1.38）]均显著增加。
在这个儿科脓毒症数据库中，更快的急诊科IVF推注速率与更高的死亡、插管和NIPPV调整后优势相关。需要进行对照试验来确定这些关联是否可重复。
