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Physiological changes following fluid bolus therapy for paediatric sepsis.

Our current understanding of sepsis is that oxygen delivery is inadequate to meet the metabolic demands of tissues. Oxygen delivery = cardiac output x haemoglobin x oxygen saturations. As such, our main forms of acute circulatory support aim to increase cardiac output. This study was undertaken to see what effect fluid bolus therapy has on cardiac output. We enrolled patients whose treating clinician diagnosed sepsis, and who was planning on treating the patient with fluid bolus therapy. We performed a trans-thoracic echocardiogram before, immediately after, and 60 minutes after fluid bolus therapy and recorded the images. These recorded images were then interpreted offline by a Paediatric Cardiologist blinded to the patient identity and status pre/post fluid bolus.


Recruitment stats:

  • 44 patients screened
  • 41 enrolled
  • 50 fluid boluses recorded.

Recruitment now closed


News:

This project was a higher degree sponsored by PREDICT. Very excited to be almost finished! The study results have been analysed, and resulting manuscripts submitted for publication. Three of four have been accepted for publication thus far:

  • “Cardiac index changes with fluid bolus therapy in children with sepsis-an observational study”; Pediatric Critical Care Medicine.
  • “Does respiratory variation of inferior vena cava diameter predict fluid responsiveness in spontaneously ventilating children with sepsis”;   Emergency Medicine Australasia.
  • “The effect of fluid bolus therapy on extravascular lung water measured using lung ultrasound in children with a presumptive clinical   diagnosis of sepsis”; Journal of Ultrasound in Medicine.

The final results manuscript is under review by Pediatric Critical Care Medicine: “Blood pressure and vascular resistance changes following fluid bolus therapy for pediatric sepsis”.

The thesis manuscript itself is in draft form and being reviewed by my PhD supervisor’s. I am planning to submit by the end of November.

I hope that the skills learned from going through this PhD, and some of the results themselves, will lead to future projects within the PREDICT network.

I would like to sincerely thank the PREDICT network for their support with this project, I am looking forward to continued involvement!

Elliot Long.