686 - IV bolus, maintenance, and drug co-administered fluid in children with community acquired sepsis.

Publication Number: 3663.686

Elliot Long, The Royal Children's Hospital, CLIFTON HILL, Victoria, Australia; Chris J. Selman, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Meredith L. Borland, University of Western Australia, Nedlands, Western Australia, Australia; Shane George, Griffith University, Gold Coast, Queensland, Australia; Shefali Jani, SCHN, Castle Hill, New South Wales, Australia; Eunicia Tan, The University of Auckland, Auckland, Auckland, New Zealand; Natalie Phillips, Queensland Children’s Hospital, Windsor, Queensland, Australia; Amit Kochar, Womens And Childrens Hospital, ADELAIDE, South Australia, Australia; Simon Craig, Monash University, Clayton, Victoria, Australia; Emma Whyte, Queensland Health, Townsville, Queensland, Australia; stuart R. Dalziel, Starship Children's Hospital, Auckland, Auckland, New Zealand; Scott L.. Weiss, Nemours Children's Hospital, Wilmington, DE, United States; Nathan Kuppermann, Children's National Health System, Washington, DC, United States; Amanda Williams, MCRI/RCH, Parkville, Victoria, Australia; Franz E. Babl, The Royal Children's Hospital, Melbourne, Victoria, Australia

Background: Intravenous fluid volume is associated with sepsis outcome, yet the contribution of maintenance, bolus, and drug co-administered fluid is not well understood.

Objective: We describe total fluid administered within the first 24-hours of treatment of children with sepsis as bolus, maintenance, and medication co-administered fluid.

Design/Methods: This observational study used data from the multi-center Sepsis Epidemiology in Australian and New Zealand Emergency Departments (SENTINEL) study, collected from 2021 to 2023. Participants were children aged 0 to < 18 years with suspected sepsis admitted to the hospital through 11 emergency departments (EDs) in Australia and New Zealand. We describe the volumes of fluid administered and the mortality rates associated with different fluid volumes.

Results: A total of 5352 patients were included in the analysis, with a median age of 2.6 years (IQR 0.4 to 7.5 years), of whom 58 (1.1%) died in the hospital, and 293 (5.5%) of whom met Phoenix sepsis criteria. The median total volume of fluid administered over the initial 24 hours of hospitalization was 40.0mL/kg (IQR 20.6 to 61.5), including: bolus fluid 10.1 mL/kg (IQR 10.0 to 20.0), maintenance fluid 32.7 mL/kg (IQR 18.9 to 51.5), and medication co-administered fluid 7.0 mL/kg (IQR 3.5 to 15.0). In-hospital mortality increased with increasing volume of bolus fluid but not with increasing volume of total fluid (unadjusted OR for in-hospital mortality for >55mL/kg vs < 15mL/kg bolus fluid: 21.9, 95% CI 8.2 to 58.6; p< 0.001).

Conclusion(s): Children with sepsis receive large volumes of fluid within the first 24 hours of hospitalization. Maintenance fluid was the main contributor to total fluid volume, yet resuscitation fluid had the largest unadjusted association with in-hospital mortality.

Table 1. Demographics of children with sepsis treated with intravenous fluids
Fluids Table 1.pdf

Table 2. Bivariate analysis of in-hospital mortality by bolus fluid volume, maintenance fluid volume, drug-line fluid volume, and total fluid volume
Fluids Table 3.pdf

Figure 1. In-hospital mortality rate by fluid volume
Pediatrics fluids in sepsis Fig 2.pdf