American Journal of Pediatrics

| Peer-Reviewed |

Fluid Overload in Children with Severe Sepsis and Septic Shock

Received: 17 October 2019    Accepted: 20 December 2019    Published: 31 December 2019
Views:       Downloads:

Share This Article

Abstract

Fluid therapy is one pillar of the treatment of septic shock, however, a hydric≥10% of the weight or Fluid Overload (FO>10%) is associated with poor hospital outcomes. The present study aims to determine the FO in patients with septic shock, and its main associations in terms of mortality and morbidity. An observational and descriptive study was conducted in 49 hospitalized children with septic shock in the PICU of the Manuel Ascencio Villarroel Children’s Hospital (MAVCH); The patients were divided into two groups according to the FO>10% (22 patients) and<10% (18 patients), for their descriptive analysis we included comparison of means and calculation of the OR. Regarding the water requirements, we observed that the group with FO>10% a mean of 5681ml; while in the group with ISCH<10% the mean was 3297.8ml (p=0.19) during first 72 hours, showing greater overload with the administration of colloids and blood products (p=0.02, p=0.004). Regarding hospital outcomes, was found morbidity associated with FO>10% (respiratory dysfunction, vasopressor requirement and renal replacement therapy); The length of hospitalization and FO were not different in groups (p=0.60), but there was higher mortality of patients with FO>10% (p=0.01, OR: 5.57 IC95% 1.4-21.8). Fluids therapy of in the patient with septic shock constitutes one of the first-line hemodynamic treatments, however in limited resources settings, overload should be avoided, mainly due to associated morbidity during the first 72 hours.

DOI 10.11648/j.ajp.20190504.33
Published in American Journal of Pediatrics (Volume 5, Issue 4, December 2019)
Page(s) 299-303
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Fluid Overload, Sepsis, Septic Shock, Fluid Therapy

References
[1] Reinoso Sarah Alvarez, Sotolongo Efrem Montero, et–al. Factores clínico- epidemiológicos relacionados con sepsis en edades pediátricas. Revista de Ciencias M édicas de Pinar del Río. Volumen 20 No1, Cuba 2016.
[2] Smith Soren H, Perner Anders. Higher vs. lower fluid volume for septic shock: clinical characteristics and outcome in unselected patients in a prospective, multicenter cohort, Critical care, 2016.
[3] Sirvent Josep-M aria, Ferri Cristina, Baró Anna et–al. Fluid balance in sepsis and septic shock as a determining factor of mortality, American Journal of Emergency Medicine, Volumen 33 no 2: 186–189, 2015.
[4] Naveda E. Omar, Naveda F. Andrea, Balance hídrico positivo y alta mortalidad en niños con sepsis grave y choque séptico. Revista Elsevier, Volumen 49 No 3: 71-77, Venezuela 2016.
[5] Karthik Raghunathan, Shaw, Andrew, et - al Association Between the Choice of IV Crystalloid and In-Hospital Mortality Among Critically Ill Adults With Sepsis Critical Care M edicine. Volume 42 No7: p 1585–1591, 2014.
[6] Ingelse Sarah A, Wösten-van Asperen Roelie, et-al. Sindrome de insuficiencia respiratoria aguda pediátrica: M anejo de fluidos en la UCIP, Pediatrics critical care, Paises Bajos 2016.
[7] A. Jonathan. J. Andrew J, et–al, Las estrategias de fluidos y los resultados en pacientes con síndrome de distrés respiratorio agudo, síndrome de respuesta inflamatoria sistémica y la sepsis: un protocolo para una revisión sistemática y meta-análisis, Revista Pub Med Central, 2015.
[8] Henríquez-Palop Fernando, Antón-Pérez Gloria, et–al, La sobrecarga hídrica como biomarcador de insuficiencia cardíaca y fracaso renal agudo, Revista de nefrología, Volumen 33 no2, Madrid 2013.
[9] Rhodes Andrew, Evans Laura E, Alhazzani Waleed et–al Surviving Sepsis Campaign: International Guidelines for M anagement of Sepsis and Septic Shock: Intensive Care M ed 2016.
[10] Lira Alena and Pinsky Michael R Choices in fluid type and volume during resuscitation: impact on patient outcomes Annals of Intensive Care Volumen 4: 38 2014.
[11] Madhusudan Poorman, Kumar Tirupakuzhi Bharath Vijayaraghavan, Cove, Fluid Resuscitation in Sepsis: Reexamining the Paradigm, 2014.
[12] Riley Treavor T, Sanchez Chelsea K, Gauthier-Lewis Mary, Johnson Jessica L, A Concise Review of Colloids for Fluid Resuscitation in Severe Sepsis and Septic Shock, Intensive Care Medicine, 2014.
[13] Baghunathan, Karthik, et-al, what is the ideal crystalloid? Current Opinion in Critical Care, Volume 21, p 309–314. 2015.
[14] Latour-Pérez J. Nuevas recomendaciones sobre la utilización de soluciones de albúmina humana en pacientes con sepsis grave y shock séptico. Una evaluación crítica de la literatura, Revista Elsevier, España 2013.
[15] Castelbón Velao Ricardo Jesús. Albúmina al 4% vs. Salino 0,9% en la sepsis grave efectos sobre la mortalidad y sobre los distintos órganos. Revista electrónica de Anestesia; Vol. 3 86-96, 2011.
[16] Pietroa Caironi, Langer Thomasb, et–al. Albumin in critically ill patients: the ideal colloid? Revista Einstein volume 13 No3. San Pablo Brasil. 2015.
[17] Arriagada Daniela, Donoso Alejandro, Cruces Pablo, Díaz Franco, Choque séptico: Actualización en la monitorización hemodinámica, Santiago de Chile. 2013.
[18] Gan Heng, Cannesson M axime, Chandler John R, Ansermino J M ark. Predicting Fluid Responsiveness in Children: A Systematic Review Anales de anestesiología Volumen 6: 80- 92, 2013.
[19] Monnet Xavier, Teboul Jean-Louis, M arik Paul E. La predicción de la respuesta de fluidos: una actualización. Anales de Cuidados Intensivos Volumen 6, página111 2016.
[20] Nogueira Ávila Maria Olinda, Roca Novis Paulo, et–al. Balance hídrico, angina renal y mortalidad de los pacientes en la unidad de cuidados intensivos, Revista brasileña de nefrología Volumen 36 no 3 Sao Pablo, 2014.
[21] Aguilar Arzápalo M ario Francisco, Escalante Castillo Adrián, Asociación de los niveles elevados de cloro plasmático, en la gravedad y mortalidad de pacientes adultos en la Unidad de Cuidados Intensivos. Revista de la Asociación Mexicana de M edicina Critica y Terapia Intensiva Volumen 29 no 1: 13-21, 2015.
[22] Cecconi Maurizio, Hofer Christoph, et–al, Fluid challenges in intensive care: the FENICE study A global inception cohort study. Intensive Care Medicine, Volumen 1 No 15: 1529–1537, 2015.
[23] Rastegar, Rational Fluid Therapy for Sepsis and Septic Shock; What Do Recent Studies Tell Us?Archives of Iranian Medicine, Volume 18, Number 3: 308–313. 2015.
[24] Finfer Simon, Liu Bette, Taylor C olman, et-al, El uso de fluidos de resucitación en adultos críticamente enfermos: un estudio transversal internacional en 391 unidades de cuidados intensivos. Critical Care. Volumen 21, 2010.
[25] Martensson Johan, Bellomo Rinaldo, Are all fluids bad for the kidney? Critical Care. Volumen 21. p 302-308.2015.
[26] Correa Thiago Domingos, Rocha Leonardo Lima, et–al. Fluid therapy for septic shock resuscitation: which fluid should be used? Biomed, pagina 9, 2014.
[27] Boyd John H Suetrong Bandarn, Pisitsak Chawika, Russell A. James. hipercloremia y aumento moderado de cloruro de suero están asociados con lesión renal aguda en la sepsis severa y shock séptico pacientes, Critical Care Volumen 20, 2016.
[28] Shaw Andrew D, Schermer Carol R. Lobo Dileep N, et–al, Impacto de la composición de los fluidos por vía intravenosa en los resultados en los pacientes con síndrome de respuesta inflamatoria sistémica. Critical Care 2015 Volumen 19. 2015.
[29] Rinaldo Bellomo, Hiroshi Morimatsu, et–al. The effects of saline or albumin resuscitation on acid-base status and serum electrolytes, Critical Care M edicine, Volumen 34, pp 2891-2897. 2010.
[30] Yates D Hoste E. A, M aitland K, Cuatro fases de la terapia intravenosa de fluidos: un modelo conceptual, Revista brasileña de anestesiología Volumen 113 no 5: 740-747, 2014.
[31] Karakala Nithin, Raghunathan, Shaw D, Intravenous fluids in sepsis, what to use what to avoid: Lest we forget the endothelial glycocalyx in sepsis, Revista Current Opinion Volumen 19: 537–543. 2016.
[32] Garcia de Lorenzo Scores pronósticos y Criterios diagnósticos 2 da edición, Ediciones Ergon, M adrid–España, 2006.
[33] Copana Olmos Raul, Diaz Villalobos Willmer, Cossio Alba Nayda. Déficit de base y depuración del lactato en el paciente pediátrico con sepsis. Gac M ed Bol: 79-82. 2016.
[34] Copana Olmos Raúl Rafael, M elean Camacho Luis Gonzalo. Hiponatremia en pacientes postoperados en el Hospital del Niño Manuel Ascencio Villarroel, Cochabamba, Bolivia. Gac M ed Bol; 37 (1): 20-22. 2014.
[35] Kiguli, RO Opoka, C Engoru, P Olupot-Olupot, SO Akech, Mortality after fluid bolus in African children with severe infection. New England Journal of Medicine 364 (26), 2483-2495. 2011.
Author Information
  • Pediatric Intensive Care Department, Manuel Ascencio Villarroel Children′s Hospital, Cochabamba, Bolivia; Maternoinfantile Health Department, Medicine Faculty, San Simon University, Cochabamba, Bolivia

  • Pediatric Intensive Care Department, Ovidio Aliaga Uria Chidren′s Hospital, La Paz, Bolivia

Cite This Article
  • APA Style

    Copana Raul, Diaz Willmer. (2019). Fluid Overload in Children with Severe Sepsis and Septic Shock. American Journal of Pediatrics, 5(4), 299-303. https://doi.org/10.11648/j.ajp.20190504.33

    Copy | Download

    ACS Style

    Copana Raul; Diaz Willmer. Fluid Overload in Children with Severe Sepsis and Septic Shock. Am. J. Pediatr. 2019, 5(4), 299-303. doi: 10.11648/j.ajp.20190504.33

    Copy | Download

    AMA Style

    Copana Raul, Diaz Willmer. Fluid Overload in Children with Severe Sepsis and Septic Shock. Am J Pediatr. 2019;5(4):299-303. doi: 10.11648/j.ajp.20190504.33

    Copy | Download

  • @article{10.11648/j.ajp.20190504.33,
      author = {Copana Raul and Diaz Willmer},
      title = {Fluid Overload in Children with Severe Sepsis and Septic Shock},
      journal = {American Journal of Pediatrics},
      volume = {5},
      number = {4},
      pages = {299-303},
      doi = {10.11648/j.ajp.20190504.33},
      url = {https://doi.org/10.11648/j.ajp.20190504.33},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajp.20190504.33},
      abstract = {Fluid therapy is one pillar of the treatment of septic shock, however, a hydric≥10% of the weight or Fluid Overload (FO>10%) is associated with poor hospital outcomes. The present study aims to determine the FO in patients with septic shock, and its main associations in terms of mortality and morbidity. An observational and descriptive study was conducted in 49 hospitalized children with septic shock in the PICU of the Manuel Ascencio Villarroel Children’s Hospital (MAVCH); The patients were divided into two groups according to the FO>10% (22 patients) and10% a mean of 5681ml; while in the group with ISCH10% (respiratory dysfunction, vasopressor requirement and renal replacement therapy); The length of hospitalization and FO were not different in groups (p=0.60), but there was higher mortality of patients with FO>10% (p=0.01, OR: 5.57 IC95% 1.4-21.8). Fluids therapy of in the patient with septic shock constitutes one of the first-line hemodynamic treatments, however in limited resources settings, overload should be avoided, mainly due to associated morbidity during the first 72 hours.},
     year = {2019}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Fluid Overload in Children with Severe Sepsis and Septic Shock
    AU  - Copana Raul
    AU  - Diaz Willmer
    Y1  - 2019/12/31
    PY  - 2019
    N1  - https://doi.org/10.11648/j.ajp.20190504.33
    DO  - 10.11648/j.ajp.20190504.33
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 299
    EP  - 303
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20190504.33
    AB  - Fluid therapy is one pillar of the treatment of septic shock, however, a hydric≥10% of the weight or Fluid Overload (FO>10%) is associated with poor hospital outcomes. The present study aims to determine the FO in patients with septic shock, and its main associations in terms of mortality and morbidity. An observational and descriptive study was conducted in 49 hospitalized children with septic shock in the PICU of the Manuel Ascencio Villarroel Children’s Hospital (MAVCH); The patients were divided into two groups according to the FO>10% (22 patients) and10% a mean of 5681ml; while in the group with ISCH10% (respiratory dysfunction, vasopressor requirement and renal replacement therapy); The length of hospitalization and FO were not different in groups (p=0.60), but there was higher mortality of patients with FO>10% (p=0.01, OR: 5.57 IC95% 1.4-21.8). Fluids therapy of in the patient with septic shock constitutes one of the first-line hemodynamic treatments, however in limited resources settings, overload should be avoided, mainly due to associated morbidity during the first 72 hours.
    VL  - 5
    IS  - 4
    ER  - 

    Copy | Download

  • Sections