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

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OBJECTIVES: We set out to describe the amount of fluid administered within the first 24 hours of sepsis treatment with an exploratory analysis of associations. DESIGN: This prospective observational study used data from the Sepsis Epidemiology in Australian and New Zealand Emergency Departments Study, collected from 2021 to 2023. PATIENTS: 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. MAIN OUTCOMES: We describe the volumes of fluid administered and mortality rates associated with different fluid volumes. RESULTS: 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). CONCLUSION: 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.

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