The effect of fluid therapy during the first 12 hours after septic shock onset in pediatric patients

Abstract

Background: Initial fluid therapy is the cornerstone of hemodynamic resuscitation in pediatric patients with septic shock. This study investigated the association between fluid therapy during the first 12 hours after septic shock onset and the outcomes of pediatric patients. Methods: This retrospective, observational study included consecutive pediatric patients with septic shock who were admitted to a multidisciplinary pediatric intensive care unit between January 2012 and December 2019. Data on total fluid administration within the first 12 hours of septic shock onset, patient characteristics, and outcome measurements were collected from validated electronic medical records. Results: In total, 144 cases were included (overall 28-day mortality rate, 20.1%). Significant differences were found between survivors and non-survivors in the proportion of fluid received within the first 3 hours (36.9% vs. 25.4%, p =0.004) and within the last 3 hours (18.9% vs. 21.3%, p =0.031). The mortality rate was lower in patients who received a higher proportion of fluid within the first 3 hours (13.9% vs. 26.4%, p =0.048). Conversely, those with a higher proportion of fluid in the last 3 hours had a significantly higher mortality rate (29.6% vs. 14.4%, p =0.025). Multivariable logistic regression analysis revealed that a higher proportion of fluid within the first 3 hours was associated with decreased mortality (odds ratio [OR], 0.951; 95% confidence interval [CI], 0.918–0.986; p =0.028), while a higher proportion within the last 3 hours was associated with increased mortality (OR, 2.761; 95% CI, 1.175–6.495; p =0.020). Conclusion: Higher fluid intake during the initial 3 hours after septic shock onset was linked to a reduction in 28-day mortality among pediatric patients; conversely, higher fluid volume during the final 3 hours of the 12-hour period post-onset was correlated with worse survival outcomes. Providing an adequate fluid volume within the first 3 hours, followed by a more conservative approach to fluid administration, may contribute to decreased mortality.