Timing of antibiotics, volume, and vasoactive infusions in children with sepsis admitted to intensive care.
BACKGROUND
Early administration of antibiotics for sepsis, and of fluid boluses and vasoactive agents for septic shock, is recommended. Evidence for this in children is limited.


METHODS
The Alberta Sepsis Network prospectively enrolled eligible children admitted to the Pediatric Intensive Care Unit (PICU) with sepsis from 04/2012-10/2014. Demographics, severity of illness, and outcomes variables were prospectively entered into the ASN database after deferred consent. Timing of interventions were determined by retrospective chart review using a study manual and case-report-form. We aimed to determine the association of intervention timing and outcome in children with sepsis. Univariate (t-test and Fisher's Exact) and multiple linear regression statistics evaluated predictors of outcomes of PICU length of stay (LOS) and ventilation days.


RESULTS
Seventy-nine children, age median 60 (IQR 22-133) months, 40 (51%) female, 39 (49%) with severe underlying co-morbidity, 44 (56%) with septic shock, and median PRISM-III 10.5 [IQR 6.0-17.0] were enrolled. Most patients presented in an ED: 36 (46%) at an outlying hospital ED, and 21 (27%) at the Children's Hospital ED. Most infections were pneumonia with/without empyema (42, 53%), meningitis (11, 14%), or bacteremia (10, 13%). The time from presentation to acceptable antibiotic administration was a median of 115.0 [IQR 59.0-323.0] minutes; 20 (25%) of patients received their antibiotics in the first hour from presentation. Independent predictors of PICU LOS were PRISM-III, and severe underlying co-morbidity, but not time to antibiotics. In the septic shock subgroup, the volume of fluid boluses given in the first 2 hours was independently associated with longer PICU LOS (effect size 0.22 days; 95% CI 0.5, 0.38; per ml/kg). Independent predictors of ventilator days were PRISM-III score and severe underlying co-morbidity. In the septic shock subgroup, volume of fluid boluses in the first 2 hours was independently associated with more ventilator days (effect size 0.09 days; 95% CI 0.02, 0.15; per ml/kg).


CONCLUSIONS
Higher volume of early fluid boluses in children with sepsis and septic shock was independently associated with longer PICU LOS and ventilator days. More study on the benefits and harms of fluid bolus therapy in children are needed.
Department of Pediatrics, Sophia Childrens Hospital Erasmus University Medical Centre, Rotterdam, The Netherlands. bmvanparidon@gmail.com.
Bregje M
BM
van Paridon
Faculty of Nursing, University of Alberta, Edmonton, AB, Canada. cathy.sheppard@albertahealthservices.ca.
Cathy
C
Sheppard
Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alberta, Edmonton, AB, Canada. gonzalo.guerra@albertahealthservices.ca.
Garcia Guerra
GG
G
Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alberta, Edmonton, AB, Canada. ari.joffe@albertahealthservices.ca.|4-546 Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, AB, T6G 1C9, Canada. ari.joffe@albertahealthservices.ca.
Ari R
AR
Joffe
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D005440:Fluid Therapy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D018805:Sepsis / Q000188:drug therapy*
D000900:Anti-Bacterial Agents