Restricted fluid bolus volume in early septic shock: Results of the Fluids in Shock pilot trial

Inwald, David; Canter, Ruth; Woolfall, Kerry; Mouncey, Paul; Zenasni, Zohra; O'Hara, Caitlin; Carter, Anjali; Jones, Nicola; Lyttle, Mark D.; Nadel, Simon; Peters, Mark J.; Rowan, Kathryn

Abstract

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. Objective To determine the feasibility of Fluids in Shock, a randomised controlled trial (RCT) of restricted fluid bolus volume (10 mL/kg) versus recommended practice (20 mL/kg). Design Nine-month pilot RCT with embedded mixed-method perspectives study. Setting 13 hospitals in England. Patients Children presenting to emergency departments with suspected infection and shock after 20 mL/kg fluid. Interventions Patients were randomly allocated (1:1) to further 10 or 20 mL/kg fluid boluses every 15 min for up to 4 hours if still in shock. Main outcome measures These were based on progression criteria, including recruitment and retention, protocol adherence, separation, potential trial outcome measures, and parent and staff perspectives. Results Seventy-five participants were randomised; two were withdrawn. 23 (59%) of 39 in the 10 mL/kg arm and 25 (74%) of 34 in the 20 mL/kg arm required a single trial bolus before the shock resolved. 79% of boluses were delivered per protocol in the 10 mL/kg arm and 55% in the 20 mL/kg arm. The volume of study bolus fluid after 4 hours was 44% lower in the 10 mL/kg group (mean 14.5 vs 27.5 mL/kg). The Paediatric Index of Mortality-2 score was 2.1 (IQR 1.6-2.7) in the 10 mL/kg group and 2.0 (IQR 1.6-2.5) in the 20 mL/kg group. There were no deaths. Length of hospital stay, paediatric intensive care unit (PICU) admissions and PICU-free days at 30 days did not differ significantly between the groups. In the perspectives study, the trial was generally supported, although some problems with protocol adherence were described. Conclusions Participants were not as unwell as expected. A larger trial is not feasible in its current design in the UK. Trial registration number ISRCTN15244462.

• Journal Article Type: Article
• Acceptance Date: Jul 15, 2018
• Online Publication Date: Aug 7, 2018
• Publication Date: May 1, 2019
• Deposit Date: Aug 14, 2018
• Publicly Available Date: Aug 14, 2018
• Journal: Archives of Disease in Childhood
• Print ISSN: 0003-9888
• Electronic ISSN: 1468-2044
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 104
• Issue: 5
• Pages: 426-431
• DOI: https://doi.org/10.1136/archdischild-2018-314924
• Keywords: shock, child, fluid, resuscitation
• Public URL: https://uwe-repository.worktribe.com/output/863121
• Publisher URL: https://adc.bmj.com/content/early/2018/08/07/archdischild-2018-314924
• Contract Date: Aug 14, 2018