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VOLUME 27 , ISSUE 2 ( February, 2023 ) > List of Articles

Pediatric Critical Care

A Study to Compare Ultrasound-guided and Clinically-guided Fluid Management in Children with Septic Shock

Ryan Sohail Kaiser, Mihir Sarkar, Sumantra Kumar Raut, Manas Kumar Mahapatra, Mohammad Asraf Uz Zaman, Oishik Roy, Satyabrata Roy Chowdhoury, Mousumi Nandi

Keywords : Cumulative fluid balance, Fluid resuscitation, Pediatric, Septic shock, Ultrasound

Citation Information : Kaiser RS, Sarkar M, Raut SK, Mahapatra MK, Zaman MA, Roy O, Roy Chowdhoury S, Nandi M. A Study to Compare Ultrasound-guided and Clinically-guided Fluid Management in Children with Septic Shock. Indian J Crit Care Med 2023; 27 (2):139-146.

DOI: 10.5005/jp-journals-10071-24410

License: CC BY-NC 4.0

Published Online: 31-01-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Background: To evaluate the role of ultrasound during initial fluid resuscitation along with clinical guidance in reducing the incidence of fluid overload on day 3 in children with septic shock. Materials and methods: It was a prospective, parallel limb open-labeled randomized controlled superiority trial done in the PICU of a government-aided tertiary care hospital in Eastern India. Patient enrolment took place between June 2021 and March 2022. Fifty-six children aged between 1 month and 12 years, with proven or suspected septic shock, were randomized to receive either ultrasound-guided or clinically guided fluid boluses (1:1 ratio) and subsequently followed up for various outcomes. The primary outcome was frequency of fluid overload on day 3 of admission. The treatment group received ultrasound-guided fluid boluses along with the clinical guidance and the control group received the same but without ultrasound guidance upto 60 mL/kg of fluid boluses. Results: The frequency of fluid overload on day 3 of admission was significantly lower in the ultrasound group (25% vs 62%, p = 0.012) as was the median (IQR) cumulative fluid balance percentage on day 3 [6.5 (3.3–10.3) vs 11.3 (5.4–17.5), p = 0.02]. The amount of fluid bolus administered was also significantly lower by ultrasound [median 40 (30–50) vs 50 (40–80) mL/kg, p = 0.003]. Resuscitation time was shorter in the ultrasound group (13.4 ± 5.6 vs 20.5 ± 8 h, p = 0.002). Conclusion: Ultrasound-guided fluid boluses were found to be significantly better than clinically guided therapy, in preventing fluid overload and its associated complications in children with septic shock. These factors make ultrasound a potentially useful tool for resuscitation of children with septic shock in the PICU.

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