Cardiac Index Changes With Fluid Bolus Therapy in Children With Sepsis—An Observational Study

Objectives: Fluid bolus therapy is the initial recommended treatment for acute circulatory failure in sepsis, yet it is unknown whether this has the intended effect of increasing cardiac index. We aimed to describe the effect of fluid bolus therapy on cardiac index in children with sepsis. Design: A prospective observational cohort study. Setting: The Emergency Department of The Royal Children’s Hospital, Melbourne, VIC, Australia. Patients: A convenience sample of children meeting international consensus criteria for sepsis with acute circulatory failure. Intervention: Treating clinician decision to administer fluid bolus therapy. Measurements and Main Results: Transthoracic echocardiography was recorded immediately before, 5 minutes after, and 60 minutes after fluid bolus therapy. Cardiac index was calculated by a pediatric cardiologist blinded to the timing of the echocardiogram. Cardiac index was calculated for 49 fluid boluses in 41 children. The median change in cardiac index 5 minutes after a fluid bolus therapy was +18.0% (interquartile range, 8.6–28.1%) and after 60 minutes was –6.0% (interquartile range, –15.2% to 3.0%) relative to baseline. Thirty-one of 49 fluid boluses (63%) resulted in an increase in cardiac index of greater than 10% at 5 minutes, and these participants were considered fluid responsive. This was sustained in four of 31 (14%) at 60 minutes. No association between change in cardiac index at 5 or 60 minutes and age, baseline mean arterial blood pressure, fluid bolus volume, and prior volume of fluid bolus therapy was found on linear regression. Conclusions: Fluid bolus therapy for pediatric sepsis is associated with a transient increase in cardiac index. Fluid responsiveness is variable and, when present, not sustained. The efficacy of fluid bolus therapy for achieving a sustained increase in cardiac index in children with sepsis is limited. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://ift.tt/2gIrZ5Y). Supported, in part, by a Windermere Foundation Doctoral Scholarship in Health, a National Health and Medical Research Council Centre of Research Excellence Grant for Pediatric Emergency Medicine (GNT1058560), Canberra, ACT, Australia, the Victorian Governments Infrastructure Support Program, Melbourne, VIC, Australia, a Shields Research Entry Scholarship provided by the Royal Australasian College of Physicians, Sydney, NSW, Australia, and a Clinical Sciences Theme Grant provided by The Royal Children’s Hospital Foundation, Melbourne, VIC, Australia. Dr. Babl’s institution received funding from the National Health and Medical Research Council (NHMRC) Centres of Research Excellence grant and NHMRC Practitioner Fellowship. He was supported by a Melbourne Children’s Clinician Scientist Fellowship, Melbourne, VIC, Australia, and an NHMRC Practitioner Fellowship. Dr. Sheridan received funding from Extracorporeal Life Support Organization (conference fees and accommodation costs for invited speaker). The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: Elliot.long@rch.org.au ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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