In the United States, more than 75,000 children develop severe sepsis each year. 1 out of 12 kids in any pediatric ICU around the world has sepsis. Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency that happens when chemicals released in the bloodstream to fight an infection trigger inflammation throughout the body. Infections that lead to sepsis most often start in the lung, urinary tract, skin or gastrointestinal tract. Symptoms include fever, difficulty breathing, low blood pressure, fast heart rate and mental confusion.
Early treatment is simple and lifesaving
Early treatment, which is simple and lifesaving, includes antibiotics and intravenous fluids. While fluid replacement has been a mainstay of sepsis care, it has been unclear whether delivering a specific volume of fluid in the first hour of care improves outcomes. In fact, whether to target a specific volume in clinical care and sepsis quality metrics has been a topic of much debate.
Importance of first-hour fluid replacement
Halden Scott, MD, a pediatric emergency physician at Children’s Hospital Colorado, led a recent research study on the importance of first-hour fluid replacement for patients with septic shock. Dr. Scott was the study’s senior author, along with a multi-institutional team of researchers including first author Matthew Eisenberg, MD, a pediatric emergency physician in Boston. They used a learning health system approach, by gathering data from 57 US hospitals participating in the Children’s Hospital Association’s (CHA) quality improvement (QI) collaborative to generate new knowledge and inform care.
Findings on the impact of fluid volume
In this study, researchers examined children with hypotensive septic shock who all received timely, first-hour fluid resuscitation in the emergency department with a focus on swift, quality sepsis care. In this context, they did not find an association between mortality and receiving a specific volume of fluids over the first hour (they compared >= 30 mL/kg vs. <30 mL/kg). This study suggests against setting a specific fluid volume target as a measure of quality of care. These findings continue to emphasize the importance of prompt sepsis care and suggest that tailoring the volume of fluid resuscitation to the individual patient is appropriate. This was a retrospective study, and future prospective studies might illuminate questions of early fluid resuscitation volume further.
Attentive care is most important
“There is not a one size fits all. It is about the fluid given in a timely manner that matters,” said Dr. Scott. “It should be tuned to the specific patient in front of you – as we believe attentive care is most important. It gives the ability of the team at the bedside to give timely quality efforts.”
Focus on sepsis care at Children’s Colorado
Children’s Colorado started its sepsis program in 2012, supported by strong clinical and research informatics and Clinical Effectiveness teams that facilitated internal data-driven QI and research. In addition to improving its own care, Children’s Colorado participated in the CHA sepsis collaborative to share and learn from data, research and QI findings with other participating hospitals around the country.
Improving pediatric sepsis care
Dr. Scott has served as a national Steering Committee member of the CHA sepsis collaborative since it began in 2015 and was the first research committee co-chair who ensured that the data gathered for QI would be used for research as well. This sepsis study publication is the 4th publication to result from the collaborative, which has improved the quality of sepsis care at children’s hospitals across the country.