IV bolus, maintenance and medication carrier fluid in children with community-acquired sepsis: a multicentre cohort study.

Abstract

We set out to describe the amount of fluid administered within the first 24 hours of sepsis treatment with an exploratory analysis of associations. This prospective observational study used data from the Sepsis Epidemiology in Australian and New Zealand Emergency Departments Study, collected from 2021 to 2023. Participants were children aged 0 years to <18 years with suspected community-acquired sepsis admitted to the hospital through 11 emergency departments in Australia and New Zealand. We describe the volumes of fluid administered and mortality rates associated with different fluid volumes. A total of 5352 patients were included in the analysis, with a median age of 2.6 years (IQR 0.4-7.5 years), in-hospital mortality of 58 (1.1%), and 293 (5.5%) of whom met Phoenix sepsis criteria. The median total volume of fluid administered over the initial 24 hours of hospitalisation was 40.0 mL/kg (IQR 20.6-61.5 mL/kg), including: bolus fluid 10.0 mL/kg (IQR 9.4-19.9 mL/kg), maintenance fluid 27.1 mL/kg (IQR 10.2-47.3 mL/kg) and medication carrier fluid 0.0 mL/kg (IQR 0.0-0.9 mL/kg). In-hospital mortality increased with increasing volume of bolus fluid but not with increasing volume of total fluid (unadjusted OR for in-hospital mortality for >55 mL/kg vs <15 mL/kg bolus fluid: 20.5, 95% CI 8.0 to 52.5; p<0.001). Although maintenance fluids accounted for the largest proportion of total fluid volume, bolus fluids showed the strongest association with in-hospital mortality in unadjusted analyses.