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|Critical Connections Spring 2020
Sepsis and Children
|Critical Connections Summer 2020
COVID-19: Rising to the Challenge
The Spring issue of Critical Connections featured an article on the new Surviving Sepsis Campaign (SSC) Pediatric Sepsis Guidelines that included potentially misleading information regarding the delivery of bolus fluid in the first hour of treatment. To ensure accuracy and clarity, the statement on page 9 should read as follows:
Children who are being treated in healthcare systems where intensive care is available (on site or through transport) should be provided up to 40-60 mL/kg bolus fluid in the first hour of treatment, based on cardiac output and discontinued if they exhibit signs of fluid overload. However, healthcare systems where intensive care is not available or accessible may not have the resources to manage fluid overload and therefore should not administer a bolus of fluid (unless the child has extremely low blood pressure) and instead provide maintenance fluid.
In other words, as long as there is ICU capability – where fluid overload can be managed if it occurs – the SSC suggests that children receive bolus fluid in the first hour.
The previous version noted that health systems without ICUs should not provide bolus fluid because they may not have the resources to assess and manage fluid overload. This direction is not applicable in settings where community hospitals without ICUs can readily transfer children to larger hospitals that offer that level of care or in settings where advanced hemodynamic and respiratory care can be provided outside of a formal ICU. Simply put, if intensive care is accessible (even if not on site), the SSC suggests the child be provided up to 40-60 mL/kg bolus fluid in the first hour of treatment, based on cardiac output and discontinued if they exhibit signs of fluid overload.
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