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15 Conventional vs. Restrictive Maintenance Fluid Regime in Children with Septic Shock after Initial Resuscitation: A Randomized Open Label Controlled Trial
  1. G Benakatti,
  2. S Singhi,
  3. J Muralidharan,
  4. A Bansal
  1. Pediatrics, Post Graduate Institute of Medical Education and Reasearch (PGIMER), Chandigarh, India

Abstract

Background Initial aggressive fluid resuscitation is of proven benefit in septic shock. Optimal post resuscitation fluid management is not known.

Aims To compare restrictive vs. conventional post-resuscitation fluid protocols in children with septic shock.

Methods We performed prospective randomized trial involving children (3 to144 months) with septic shock admitted to our PICU. After initial resuscitation, patients were randomly assigned to restrictive (A) or conventional (B) fluid protocol. The primary end point was length of PICU stay. Secondary end points included: all cause mortality, organ failure free days, ventilator-free days, measures of lung physiology and incidence of AKI. All analyses were performed on intention-to-treat basis. Intergroup differences were tested with Students’ t test, Chi-square and Mann Whitney U test as appropriate and ANOVA for repeated measures. Time to event data was analyzed with Kaplan-Meier method and Mantel-Cox log rank test.

Results In 12 months period, total of 101 children were enrolled. The baseline characteristics of both groups were similar. The mean (±SD) cumulative fluid balance in initial ten days was - 42.6±82.6 ml (group A) and 339±117 ml (group B) (P<0.001). As compared to Group B, group A showed significantly more PICU free days [17.2±9vs.12.7 ±9.5days; p=0.015], lesser number of organ failures [p=0.001], higher proportion of patients recovering from organ failure [92.5vs.75%; p=0.005], improved oxygenation index and plateau pressure [p=0.001], lesser duration of ventilation [6.3±5.8 vs.9.9±5.2days; p=0.012], early recovery from shock [92.5±68.8 vs.123±87 hours; p=0.05]. Mortality was similar [18.5vs.23.4%; p=0.54].

Conclusions Restrictive fluid strategy improved lung function; shortened ventilation and ICU stay without aggravating the hemodynamic instability.

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