Fluid bolus therapy in pediatric sepsis: a narrative review (2024)

1. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395:200–211. [PMC free article] [PubMed] [Google Scholar]

2. Martinón-Torres F, Salas A, Rivero-Calle I, Cebey-López M, Pardo-Seco J, Herberg JA, et al. Life-threatening infections in children in Europe (the EUCLIDS Project): a prospective cohort study. Lancet Child Adolesc Health. 2018;2:404–414. [PubMed] [Google Scholar]

3. Tan B, Wong JJ-M, Sultana R, Koh JC, Jit M, Mok YH, et al. Global case-fatality rates in pediatric severe sepsis and septic shock: a systematic review and meta-analysis. JAMA Pediatr. 2019;173:352–62. [PMC free article] [PubMed]

4. Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, Schlapbach LJ, Reinhart K, Kissoon N. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Resp Med. 2018;6:223–230. [PubMed] [Google Scholar]

5. Weiss SL, Fitzgerald JC, Pappachan J, Wheeler D, Jaramillo-Bustamante JC, Salloo A, et al. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies study. Am J Respir Crit Care Med. 2015;191:1147–1157. [PMC free article] [PubMed] [Google Scholar]

6. Schlapbach LJ, Straney L, Alexander J, MacLaren G, Festa M, Schibler A, et al. Mortality related to invasive infections, sepsis, and septic shock in critically ill children in Australia and New Zealand, 2002–13: a multicentre retrospective cohort study. Lancet Infect Dis. 2015;15:46–54. [PubMed] [Google Scholar]

7. Prout AJ, Talisa VB, Carcillo JA, Mayr FB, Angus DC, Seymour CW, et al. Children with chronic disease bear the highest burden of pediatric sepsis. J Pediatr. 2018;199:194–199.e1. [PMC free article] [PubMed] [Google Scholar]

8. Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6:2–8. [PubMed]

9. Weiss SL, Fitzgerald JC, Maffei FA, Kane JM, Rodriguez-Nunez A, Hsing DD, et al. Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study. Crit Care. 2015;19:325. [PMC free article] [PubMed] [Google Scholar]

10. Scott HF, Deakyne SJ, Woods JM, Bajaj L. The prevalence and diagnostic utility of systemic inflammatory response syndrome vital signs in a pediatric emergency department. Acad Emerg Med. 2015;22:381–389. [PubMed] [Google Scholar]

11. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) JAMA. 2016;315:801–810. [PMC free article] [PubMed] [Google Scholar]

12. Morin L, Hall M, de Souza D, Guoping L, Jabornisky R, Shime N, et al. The current and future state of pediatric sepsis definitions: an international survey. Pediatrics. 2022;149:e2021052565. [PubMed] [Google Scholar]

13. Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020;46:10–67. [PMC free article] [PubMed] [Google Scholar]

14. Rodrigues-Santos G, de Magalhães-Barbosa MC, Raymundo CE, Lima-Setta F, da Cunha AJLA, Prata-Barbosa A. Improvement of 1st-hour bundle compliance and sepsis mortality in pediatrics after the implementation of the surviving sepsis campaign guidelines. J Pediatr (Rio J) 2021;97:459–467. [PMC free article] [PubMed] [Google Scholar]

15. Gelbart B, Schlapbach L, Ganeshalingham A, Ganu S, Erickson S, Oberender F, et al. Fluid bolus therapy in critically ill children: a survey of practice among paediatric intensive care doctors in Australia and New Zealand. Crit Care Resusc. 2018;20:131–138. [PubMed] [Google Scholar]

16. Samransamruajkit R, Wong JJM, Smathakane C, Anantasit N, Sunkonkit K, Ong J, et al. Pediatric severe sepsis and shock in three Asian countries: a retrospective study of outcomes in nine PICUs. Pediatr Crit Care Med. 2021;1:1. [PubMed] [Google Scholar]

17. Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, et al. European resuscitation council guidelines 2021: paediatric life support. Resuscitation. 2021;161:327–387. [PubMed] [Google Scholar]

18. Fuhrman DY, Kellum JA. Hyperchloremic IV solutions: have we seen enough?…or “Still Good Medicine?” Pediatr Crit Care Med. 2018;19:171–172. [PubMed] [Google Scholar]

19. Carcillo JA, Tasker RC. Fluid resuscitation of hypovolemic shock: acute medicine’s great triumph for children. Intensive Care Med. 2006;32:958–961. [PubMed] [Google Scholar]

20. Long E, Duke T. Fluid resuscitation therapy for paediatric sepsis. J Paediatr Child Health. 2016;52:141–146. [PubMed] [Google Scholar]

21. Ranjit S, Natraj R, Kissoon N, Thiagarajan R, Ramakrishnan B, Monge Garcia MI. Variability in the Hemodynamic Response to Fluid Bolus in Pediatric Septic Shock. Pediatr Crit Care Med. 2021; [PubMed]

22. Long E, Babl FE, Oakley E, Sheridan B, Duke T. Pediatric Research in Emergency Departments International Collaborative (PREDICT). Cardiac index changes with fluid bolus therapy in children with sepsis-an observational study. Pediatr Crit Care Med. 2018;19:513–518. [PubMed] [Google Scholar]

23. Long E, Babl F, Dalziel S, Dalton S, Etheridge C, Duke T, et al. Fluid resuscitation for paediatric sepsis: a survey of senior emergency physicians in Australia and New Zealand. Emerg Med Australas. 2015;27:245–250. [PubMed] [Google Scholar]

24. Gelbart B. Fluid bolus therapy in pediatric sepsis: current knowledge and future direction. Front Pediatr. 2018;6:308. [PMC free article] [PubMed] [Google Scholar]

25. Carcillo JA, Davis AL, Zaritsky A. Role of early fluid resuscitation in pediatric septic shock. JAMA. 1991;266:1242–1245. [PubMed] [Google Scholar]

26. Hilton AK, Bellomo R. A critique of fluid bolus resuscitation in severe sepsis. Crit Care. 2012;16:302. [PMC free article] [PubMed] [Google Scholar]

27. Myburgh J, Finfer S. Causes of death after fluid bolus resuscitation: new insights from FEAST. BMC Med. 2013;11:67. [PMC free article] [PubMed] [Google Scholar]

28. Duke T. What the African fluid-bolus trial means. Lancet. 2011;378:1685–1687. [PubMed] [Google Scholar]

29. Alobaidi R, Basu RK, DeCaen A, Joffe AR, Lequier L, Pannu N, et al. Fluid accumulation in critically ill children. Crit Care Med. 2020;48:1034–1041. [PubMed] [Google Scholar]

30. Alobaidi R, Morgan C, Basu RK, Stenson E, Featherstone R, Majumdar SR, et al. Association between fluid balance and outcomes in critically ill children: a systematic review and meta-analysis. JAMA Pediatr. 2018;172:257–268. [PMC free article] [PubMed] [Google Scholar]

31. Abulebda K, Cvijanovich NZ, Thomas NJ, Allen GL, Anas N, Bigham MT, et al. Post-ICU admission fluid balance and pediatric septic shock outcomes: a risk-stratified analysis. Crit Care Med. 2014;42:397–403. [PMC free article] [PubMed] [Google Scholar]

32. Bhaskar P, Dhar AV, Thompson M, Quigley R, Modem V. Early fluid accumulation in children with shock and ICU mortality: a matched case-control study. Intensive Care Med. 2015;41:1445–1453. [PubMed] [Google Scholar]

33. Chen J, Li X, Bai Z, Fang F, Hua J, Li Y, et al. Association of Fluid Accumulation with Clinical Outcomes in Critically Ill Children with Severe Sepsis. PLoS ONE. 2016;11:e0160093. [PMC free article] [PubMed] [Google Scholar]

34. Kishen R, Honoré PM, Jacobs R, Joannes-Boyau O, De Waele E, De Regt J, et al. Facing acid-base disorders in the third millennium - the Stewart approach revisited. Int J Nephrol Renovasc Dis. 2014;7:209–217. [PMC free article] [PubMed] [Google Scholar]

35. Morgan TJ, Venkatesh B, Hall J. Crystalloid strong ion difference determines metabolic acid-base change during acute normovolaemic haemodilution. Intensive Care Med. 2004;30:1432–1437. [PubMed] [Google Scholar]

36. Li H, Sun S, Yap JQ, Chen J, Qian Q. 0.9% saline is neither normal nor physiological. J Zhejiang Univ Sci B. 2016;17:181–7. [PMC free article] [PubMed]

37. Lobo DN, Awad S. Should chloride-rich crystalloids remain the mainstay of fluid resuscitation to prevent “pre-renal” acute kidney injury?: con. Kidney Int. 2014;86:1096–1105. [PMC free article] [PubMed] [Google Scholar]

38. Semler MW, Kellum JA. Balanced Crystalloid Solutions. Am J Respir Crit Care Med. 2018;199:952–960. [PMC free article] [PubMed] [Google Scholar]

39. Bulfon AF, Alomani HL, Anton N, Comrie BT, Rochwerg B, Stef SA, et al. Intravenous fluid prescription practices in critically ill children: a shift in focus from natremia to chloremia? J Pediatr Intensive Care. 2019;8:218–225. [PMC free article] [PubMed] [Google Scholar]

40. Barhight MF, Lusk J, Brinton J, Stidham T, Soranno DE, Faubel S, et al. Hyperchloremia is independently associated with mortality in critically ill children who ultimately require continuous renal replacement therapy. Pediatr Nephrol. 2018;33:1079–1085. [PubMed] [Google Scholar]

41. Suetrong B, Pisitsak C, Boyd JH, Russell JA, Walley KR. Hyperchloremia and moderate increase in serum chloride are associated with acute kidney injury in severe sepsis and septic shock patients. Crit Care. 2016;20:315. [PMC free article] [PubMed] [Google Scholar]

42. Barhight MF, Brinton J, Stidham T, Soranno DE, Faubel S, Griffin BR, et al. Increase in chloride from baseline is independently associated with mortality in critically ill children. Intensive Care Med. 2018;44:2183–2191. [PubMed] [Google Scholar]

43. Stenson EK, Cvijanovich NZ, Anas N, Allen GL, Thomas NJ, Bigham MT, et al. Hyperchloremia is associated with complicated course and mortality in pediatric patients with septic shock. Pediatr Crit Care Med. 2018;19:155–160. [PMC free article] [PubMed] [Google Scholar]

44. Lehr AR, Rached S, Barrowman N, Tsampalieros A, Parker M, McIntyre L, et al. Balanced versus unbalanced fluid in critically ill children: systematic review and meta-analysis. Pediatr Crit Care Med. 2022;1:1. [PMC free article] [PubMed] [Google Scholar]

45. Sankar J, Jayashree M, Mahadevan S, et al. Balanced crystalloids versus saline for initial fluid resuscitation in children with septic shock. Crit Care Med. 2021;49:17–17. [Google Scholar]

46. Emrath ET, Fortenberry JD, Travers C, McCracken CE, Hebbar KB. Resuscitation with balanced fluids is associated with improved survival in pediatric severe sepsis*. Crit Care Med. 2017;45:1177–1183. [PubMed] [Google Scholar]

47. Weiss SL, Keele L, Balamuth F, Vendetti N, Ross R, Fitzgerald JC, et al. Crystalloid fluid choice and clinical outcomes in pediatric sepsis: a matched retrospective cohort study. J Pediatr. 2017;182:304–310.e10. [PMC free article] [PubMed] [Google Scholar]

48. Fernández-Sarmiento J, Alcalá-Lozano C, Barrera PA, Erazo Vargas SC, Gómez Cortes LB, Reyes CM. association between unbalanced solutions and acute kidney injury during fluid resuscitation in children with sepsis. J Intensive Care Med. 2022;37:625–632. [PubMed] [Google Scholar]

49. Weiss SL, Balamuth F, Long E, Thompson GC, Hayes KL, Katcoff H, et al. PRagMatic Pediatric Trial of Balanced vs nOrmaL Saline FlUid in Sepsis: study protocol for the PRoMPT BOLUS randomized interventional trial. Trials. 2021;22:776. [PMC free article] [PubMed] [Google Scholar]

50. Zampieri FG, Machado FR, Biondi RS, Freitas FGR, Veiga VC, Figueiredo RC, et al. Effect of intravenous fluid treatment with a balanced solution vs 0.9% saline solution on mortality in critically ill patients: the BaSICS randomized clinical trial. JAMA. 2021;326:818–829. [PMC free article] [PubMed] [Google Scholar]

51. Finfer S, Micallef S, Hammond N, Navarra L, Bellomo R, Billot L, et al. Balanced multielectrolyte solution versus saline in critically ill adults. N Engl J Med. 2022;386:815–826. [PubMed] [Google Scholar]

52. Barhight MF, Nelson D, Moran T, Christiano J, Sanchez-Pinto LN. Association between the use of balanced fluids and outcomes in critically ill children: a before and after study. Crit Care. 2021;25:266. [PMC free article] [PubMed] [Google Scholar]

53. Santi M, Lava SAG, Camozzi P, Giannini O, Milani GP, Simonetti GD, et al. The great fluid debate: saline or so-called “balanced” salt solutions? Ital J Pediatr. 2015;41:47. [PMC free article] [PubMed] [Google Scholar]

54. Hayes W. Ab-normal saline in abnormal kidney function: risks and alternatives. Pediatr Nephrol. 2019;34:1191–1199. [PMC free article] [PubMed] [Google Scholar]

55. Curran JD, Major P, Tang K, Bagshaw SM, Dionne JC, Menon K, et al. Comparison of balanced crystalloid solutions: a systematic review and meta-analysis of randomized controlled trials. Crit Care Explor. 2021;3:e0398. [PMC free article] [PubMed] [Google Scholar]

56. Shin W-J, Kim Y-K, Bang J-Y, Cho S-K, Han S-M, Hwang G-S. Lactate and liver function tests after living donor right hepatectomy: a comparison of solutions with and without lactate. Acta Anaesthesiol Scand. 2011;55:558–564. [PubMed] [Google Scholar]

57. Morgan TJ. The ideal crystalloid - what is “balanced”? Curr Opin Crit Care. 2013;19:299–307. [PubMed] [Google Scholar]

58. Taylor C, Yang L, Finfer S, Machado FR, YouZhong A, Billot L, et al. An international comparison of the cost of fluid resuscitation therapies. Aust Crit Care. 2021;34:23–32. [PubMed] [Google Scholar]

59. Ranjit S, Ramanathan G, Ramakrishnan B, Kissoon N. Targeted interventions in critically ill children with severe dengue. Indian J Crit Care Med. 2018;22:154–161. [PMC free article] [PubMed] [Google Scholar]

61. Upadhyay M, Singhi S, Murlidharan J, Kaur N, Majumdar S. Randomized evaluation of fluid resuscitation with crystalloid (saline) and colloid (polymer from degraded gelatin in saline) in pediatric septic shock. Indian Pediatr. 2005;42:223–231. [PubMed] [Google Scholar]

62. Yue J, Zheng R, Wei H, Li J, Wu J, Wang P, et al. Childhood Mortality after fluid bolus with septic or severe infection shock: a systematic review and meta-analysis. Shock. 2021;56:158–166. [PubMed] [Google Scholar]

63. Davis AL, Carcillo JA, Aneja RK, Deymann AJ, Lin JC, Nguyen TC, et al. The American College of critical care medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: executive summary. Pediatr Crit Care Med. 2017;18:884–890. [PMC free article] [PubMed] [Google Scholar]

64. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36:296–327. [PubMed] [Google Scholar]

65. Weiss SL, Nicolson SC, Naim MY. Clinical update in pediatric sepsis: focus on children with pre-existing heart disease. J Cardiothorac Vasc Anesth. 2020;34:1324–1332. [PubMed] [Google Scholar]

66. Inwald DP, Canter R, Woolfall K, Mouncey P, Zenasni Z, O’Hara C, et al. Restricted fluid bolus volume in early septic shock: results of the Fluids in Shock pilot trial. Arch Dis Child. 2019;104:426–431. [PMC free article] [PubMed] [Google Scholar]

67. Santhanam I, Sangareddi S, Venkataraman S, Kissoon N, Thiruvengadamudayan V, Kasthuri RK. A prospective randomized controlled study of two fluid regimens in the initial management of septic shock in the emergency department. Pediatr Emerg Care. 2008;24:647–655. [PubMed] [Google Scholar]

68. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021;49:e1063. [PubMed] [Google Scholar]

69. Kuttab HI, Lykins JD, Hughes MD, Wroblewski K, Keast EP, Kukoyi O, et al. Evaluation and predictors of fluid resuscitation in patients with severe sepsis and septic shock. Crit Care Med. 2019;47:1582–1590. [PMC free article] [PubMed] [Google Scholar]

70. Zampieri FG, Machado FR, Biondi RS, Freitas FGR, Veiga VC, Figueiredo RC, et al. Effect of slower vs faster intravenous fluid bolus rates on mortality in critically ill patients: the basics randomized clinical trial. JAMA. 2021;326:830–838. [PMC free article] [PubMed] [Google Scholar]