Association Between the First-Hour Intravenous Fluid Volume and Mortality in Pediatric Septic Shock

IPSO collaborative investigators

doi:10.1016/j.annemergmed.2022.04.008

Association Between the First-Hour Intravenous Fluid Volume and Mortality in Pediatric Septic Shock

IPSO collaborative investigators

Pediatrics

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Study objective: To determine whether the receipt of more than or equal to 30 mL/kg of intravenous fluid in the first hour after emergency department (ED) arrival is associated with sepsis-attributable mortality among children with hypotensive septic shock. Methods: This is a retrospective cohort study set in 57 EDs in the Improving Pediatric Sepsis Outcomes quality improvement collaborative. Patients less than 18 years of age with hypotensive septic shock who received their first intravenous fluid bolus within 1 hour of arrival at the ED were propensity-score matched for probability of receiving more than or equal to 30 mL/kg in the first hour. Sepsis-attributable mortality was compared. We secondarily evaluated the association between the first-hour fluid volume and sepsis-attributable mortality in all children with suspected sepsis in the first hour after arrival at the ED, regardless of blood pressure. Results: Of the 1,982 subjects who had hypotensive septic shock and received a first fluid bolus within 1 hour of arrival at the ED, 1,204 subjects were propensity matched. In the matched patients receiving more than or equal to 30 mL/kg of fluid, 26 (4.3%) of 602 subjects had 30-day sepsis-attributable mortality compared with 25 (4.2%) of 602 receiving less than 30 mL/kg (odds ratio 1.04, 95% confidence interval 0.59 to 1.83). Among the patients with suspected sepsis regardless of blood pressure, 30-day sepsis-attributable mortality was 3.0% in those receiving more than or equal to 30 mL/kg versus 2.0% in those receiving less than 30 ml/kg (odds ratio 1.52, 95% confidence interval 0.95 to 2.44.) Conclusion: In children with hypotensive septic shock receiving a timely first fluid bolus within the first hour of ED care, receiving more than or equal to 30 mL/kg of bolus intravenous fluids in the first hour after arrival at the ED was not associated with mortality compared with receiving less than 30 mL/kg.

Original language	English (US)
Pages (from-to)	213-224
Number of pages	12
Journal	Annals of Emergency Medicine
Volume	80
Issue number	3
DOIs	https://doi.org/10.1016/j.annemergmed.2022.04.008
State	Published - Sep 2022

Funding

Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Dr. Scott's institution received career development salary support for this article from the Agency for Healthcare Research and Quality (K08HS025696). Dr. Huskins is a member of the Advisory Board, ADMA Biologics; member of the Endpoint Adjudication Committee, Pfizer; and holds stock in Pfizer, Bristol Meyers Squibb, and Zimmer Biomet. Drs. Balamuth, Brilli, Macias, Neidner, Paul, Richardson and Scott, and Ms. Riggs and Ms. DeSouza, as members of the Improving Pediatric Sepsis Outcomes Steering Committee, received travel support from the Children's Hospital Association for attendance at biannual leadership meetings. Supported by the Children's Hospital Association and Quality Improvement Learning Collaborative participant fees and in-kind support from the Children's Hospital Association. Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org ). Dr. Scott’s institution received career development salary support for this article from the Agency for Healthcare Research and Quality (K08HS025696). Dr. Huskins is a member of the Advisory Board, ADMA Biologics; member of the Endpoint Adjudication Committee, Pfizer; and holds stock in Pfizer, Bristol Meyers Squibb, and Zimmer Biomet. Drs. Balamuth, Brilli, Macias, Neidner, Paul, Richardson and Scott, and Ms. Riggs and Ms. DeSouza, as members of the Improving Pediatric Sepsis Outcomes Steering Committee, received travel support from the Children’s Hospital Association for attendance at biannual leadership meetings. Supported by the Children’s Hospital Association and Quality Improvement Learning Collaborative participant fees and in-kind support from the Children’s Hospital Association.

ASJC Scopus subject areas

Emergency Medicine

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10.1016/j.annemergmed.2022.04.008

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@article{92e20c159fb048d88543d28b8eb028d4,

title = "Association Between the First-Hour Intravenous Fluid Volume and Mortality in Pediatric Septic Shock",

abstract = "Study objective: To determine whether the receipt of more than or equal to 30 mL/kg of intravenous fluid in the first hour after emergency department (ED) arrival is associated with sepsis-attributable mortality among children with hypotensive septic shock. Methods: This is a retrospective cohort study set in 57 EDs in the Improving Pediatric Sepsis Outcomes quality improvement collaborative. Patients less than 18 years of age with hypotensive septic shock who received their first intravenous fluid bolus within 1 hour of arrival at the ED were propensity-score matched for probability of receiving more than or equal to 30 mL/kg in the first hour. Sepsis-attributable mortality was compared. We secondarily evaluated the association between the first-hour fluid volume and sepsis-attributable mortality in all children with suspected sepsis in the first hour after arrival at the ED, regardless of blood pressure. Results: Of the 1,982 subjects who had hypotensive septic shock and received a first fluid bolus within 1 hour of arrival at the ED, 1,204 subjects were propensity matched. In the matched patients receiving more than or equal to 30 mL/kg of fluid, 26 (4.3%) of 602 subjects had 30-day sepsis-attributable mortality compared with 25 (4.2%) of 602 receiving less than 30 mL/kg (odds ratio 1.04, 95% confidence interval 0.59 to 1.83). Among the patients with suspected sepsis regardless of blood pressure, 30-day sepsis-attributable mortality was 3.0% in those receiving more than or equal to 30 mL/kg versus 2.0% in those receiving less than 30 ml/kg (odds ratio 1.52, 95% confidence interval 0.95 to 2.44.) Conclusion: In children with hypotensive septic shock receiving a timely first fluid bolus within the first hour of ED care, receiving more than or equal to 30 mL/kg of bolus intravenous fluids in the first hour after arrival at the ED was not associated with mortality compared with receiving less than 30 mL/kg.",

author = "{IPSO collaborative investigators} and Eisenberg, {Matthew A.} and Ruth Riggs and Paul, {Raina Mirelia} and Fran Balamuth and Troy Richardson and DeSouza, {Heidi G.} and Abbadesa, {Mary Kate} and DeMartini, {Theodore K.M.} and Meg Frizzola and Roni Lane and Julia Lloyd and Elliot Melendez and Nikhil Patankar and Lori Rutman and Amanda Sebring and Zebulon Timmons and Scott, {Halden F.} and Auletta, {Jeffery J.} and Katie Barchi and Braun, {Benjamin R.} and Brilli, {Richard J.} and Campbell, {Deborah R.} and Chinnock, {Richard E.} and Corboy, {Jacqueline B.} and Depinet, {Holly E.} and Jill Dykstra-Nykanen and Genzel, {Karen A.} and Hana Hakim and Hron, {Jonathan D.} and Hueschen, {Leslie A.} and Huskins, {W. Charles} and Kandil, {Sarah B.} and Yu Kawai and Laurich, {V. Matt} and Loberger, {Jeremy M.} and Macias, {Charles G.} and Mackenzie, {Joan E.} and Mack, {Elizabeth H.} and Nagpal, {Ashish S.} and Matthew Niedner and Park, {Daniel B.} and Faisal Razzaqi and Redfern, {Wendi S.} and Rosen, {Johanna R.} and Rozenfeld, {Ranna A} and Sam Selby and Sharron, {Matthew P.} and Silverman, {Jonathan A.} and Spack, {Lawrence D.} and Stalets, {Erika L.}",

note = "Publisher Copyright: {\textcopyright} 2022 American College of Emergency Physicians",

year = "2022",

month = sep,

doi = "10.1016/j.annemergmed.2022.04.008",

language = "English (US)",

volume = "80",

pages = "213--224",

journal = "Annals of Emergency Medicine",

issn = "0196-0644",

publisher = "Mosby Inc.",

number = "3",

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TY - JOUR

T1 - Association Between the First-Hour Intravenous Fluid Volume and Mortality in Pediatric Septic Shock

AU - IPSO collaborative investigators

AU - Eisenberg, Matthew A.

AU - Riggs, Ruth

AU - Paul, Raina Mirelia

AU - Balamuth, Fran

AU - Richardson, Troy

AU - DeSouza, Heidi G.

AU - Abbadesa, Mary Kate

AU - DeMartini, Theodore K.M.

AU - Frizzola, Meg

AU - Lane, Roni

AU - Lloyd, Julia

AU - Melendez, Elliot

AU - Patankar, Nikhil

AU - Rutman, Lori

AU - Sebring, Amanda

AU - Timmons, Zebulon

AU - Scott, Halden F.

AU - Auletta, Jeffery J.

AU - Barchi, Katie

AU - Braun, Benjamin R.

AU - Brilli, Richard J.

AU - Campbell, Deborah R.

AU - Chinnock, Richard E.

AU - Corboy, Jacqueline B.

AU - Depinet, Holly E.

AU - Dykstra-Nykanen, Jill

AU - Genzel, Karen A.

AU - Hakim, Hana

AU - Hron, Jonathan D.

AU - Hueschen, Leslie A.

AU - Huskins, W. Charles

AU - Kandil, Sarah B.

AU - Kawai, Yu

AU - Laurich, V. Matt

AU - Loberger, Jeremy M.

AU - Macias, Charles G.

AU - Mackenzie, Joan E.

AU - Mack, Elizabeth H.

AU - Nagpal, Ashish S.

AU - Niedner, Matthew

AU - Park, Daniel B.

AU - Razzaqi, Faisal

AU - Redfern, Wendi S.

AU - Rosen, Johanna R.

AU - Rozenfeld, Ranna A

AU - Selby, Sam

AU - Sharron, Matthew P.

AU - Silverman, Jonathan A.

AU - Spack, Lawrence D.

AU - Stalets, Erika L.

PY - 2022/9

Y1 - 2022/9

N2 - Study objective: To determine whether the receipt of more than or equal to 30 mL/kg of intravenous fluid in the first hour after emergency department (ED) arrival is associated with sepsis-attributable mortality among children with hypotensive septic shock. Methods: This is a retrospective cohort study set in 57 EDs in the Improving Pediatric Sepsis Outcomes quality improvement collaborative. Patients less than 18 years of age with hypotensive septic shock who received their first intravenous fluid bolus within 1 hour of arrival at the ED were propensity-score matched for probability of receiving more than or equal to 30 mL/kg in the first hour. Sepsis-attributable mortality was compared. We secondarily evaluated the association between the first-hour fluid volume and sepsis-attributable mortality in all children with suspected sepsis in the first hour after arrival at the ED, regardless of blood pressure. Results: Of the 1,982 subjects who had hypotensive septic shock and received a first fluid bolus within 1 hour of arrival at the ED, 1,204 subjects were propensity matched. In the matched patients receiving more than or equal to 30 mL/kg of fluid, 26 (4.3%) of 602 subjects had 30-day sepsis-attributable mortality compared with 25 (4.2%) of 602 receiving less than 30 mL/kg (odds ratio 1.04, 95% confidence interval 0.59 to 1.83). Among the patients with suspected sepsis regardless of blood pressure, 30-day sepsis-attributable mortality was 3.0% in those receiving more than or equal to 30 mL/kg versus 2.0% in those receiving less than 30 ml/kg (odds ratio 1.52, 95% confidence interval 0.95 to 2.44.) Conclusion: In children with hypotensive septic shock receiving a timely first fluid bolus within the first hour of ED care, receiving more than or equal to 30 mL/kg of bolus intravenous fluids in the first hour after arrival at the ED was not associated with mortality compared with receiving less than 30 mL/kg.

AB - Study objective: To determine whether the receipt of more than or equal to 30 mL/kg of intravenous fluid in the first hour after emergency department (ED) arrival is associated with sepsis-attributable mortality among children with hypotensive septic shock. Methods: This is a retrospective cohort study set in 57 EDs in the Improving Pediatric Sepsis Outcomes quality improvement collaborative. Patients less than 18 years of age with hypotensive septic shock who received their first intravenous fluid bolus within 1 hour of arrival at the ED were propensity-score matched for probability of receiving more than or equal to 30 mL/kg in the first hour. Sepsis-attributable mortality was compared. We secondarily evaluated the association between the first-hour fluid volume and sepsis-attributable mortality in all children with suspected sepsis in the first hour after arrival at the ED, regardless of blood pressure. Results: Of the 1,982 subjects who had hypotensive septic shock and received a first fluid bolus within 1 hour of arrival at the ED, 1,204 subjects were propensity matched. In the matched patients receiving more than or equal to 30 mL/kg of fluid, 26 (4.3%) of 602 subjects had 30-day sepsis-attributable mortality compared with 25 (4.2%) of 602 receiving less than 30 mL/kg (odds ratio 1.04, 95% confidence interval 0.59 to 1.83). Among the patients with suspected sepsis regardless of blood pressure, 30-day sepsis-attributable mortality was 3.0% in those receiving more than or equal to 30 mL/kg versus 2.0% in those receiving less than 30 ml/kg (odds ratio 1.52, 95% confidence interval 0.95 to 2.44.) Conclusion: In children with hypotensive septic shock receiving a timely first fluid bolus within the first hour of ED care, receiving more than or equal to 30 mL/kg of bolus intravenous fluids in the first hour after arrival at the ED was not associated with mortality compared with receiving less than 30 mL/kg.

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DO - 10.1016/j.annemergmed.2022.04.008

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SN - 0196-0644

VL - 80

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JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

IS - 3

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Association Between the First-Hour Intravenous Fluid Volume and Mortality in Pediatric Septic Shock

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