Abstract
Objectives: To determine current practice in choice of fluid resuscitation in children following publication of a systematic review that demonstrated a higher mortality in patients treated with human albumin solution.
Methods: A descriptive telephone and postal questionnaire survey directed at the on call paediatric registrar, lead clinician for paediatrics and the paediatric pharmacist at each of 33 hospitals within the Greater London area. The study was coordinated by the Paediatric Intensive Care Unit at St Mary's Hospital, London. The questionnaire was designed to assess whether a protocol/guidelines existed for resuscitation fluid in children with septic shock; whether the participants were aware of the systematic review and if so, had it changed clinical practice. The word "protocol" was used in its broadest sense to include guideline and policy.
Results: 11 hospitals had guidelines for fluid resuscitation of septic shock in children. These varied greatly: only three gave clear instructions of which fluid to use and how to use it. Choice of fluid varied widely and there was wide discrepancy between consultant's and registrar's choice of fluid. The systematic review had lead to a change in policy in two thirds of respondents.
Conclusion: It is apparent that few paediatric departments have a written protocol or guidelines for the management of septic shock that is accessible to all those concerned in the acute treatment of seriously ill children. The systematic review into choice of fluid has had an impact on clinical practice with no data regarding whether this is in the patient's best interests.
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Selected References
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- Carcillo J. A., Davis A. L., Zaritsky A. Role of early fluid resuscitation in pediatric septic shock. JAMA. 1991 Sep 4;266(9):1242–1245. [PubMed] [Google Scholar]
- Griffel M. I., Kaufman B. S. Pharmacology of colloids and crystalloids. Crit Care Clin. 1992 Apr;8(2):235–253. [PubMed] [Google Scholar]
- Morissette M., Weil M. H., Shubin H. Reduction in colloid osmotic pressure associated with fatal progression of cardiopulmonary failure. Crit Care Med. 1975 May-Jun;3(3):115–117. doi: 10.1097/00003246-197505000-00007. [DOI] [PubMed] [Google Scholar]
- Platt M. J. Child health statistical review, 1997. Arch Dis Child. 1997 Dec;77(6):542–548. doi: 10.1136/adc.77.6.542. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pollard A. J., Britto J., Nadel S., DeMunter C., Habibi P., Levin M. Emergency management of meningococcal disease. Arch Dis Child. 1999 Mar;80(3):290–296. doi: 10.1136/adc.80.3.290. [DOI] [PMC free article] [PubMed] [Google Scholar]
- ROTHSCHILD M. A., BAUMAN A., YALOW R. S., BERSON S. A. Tissue distribution of I131 labeled human serum albumin following intravenous administration. J Clin Invest. 1955 Sep;34(9):1354–1358. doi: 10.1172/JCI103183. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rackow E. C., Falk J. L., Fein I. A., Siegel J. S., Packman M. I., Haupt M. T., Kaufman B. S., Putnam D. Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock. Crit Care Med. 1983 Nov;11(11):839–850. [PubMed] [Google Scholar]
- Rackow E. C., Fein I. A., Siegel J. The relationship of the colloid osmotic-pulmonary artery wedge pressure gradient to pulmonary edema and mortality in critically ill patients. Chest. 1982 Oct;82(4):433–437. doi: 10.1378/chest.82.4.433. [DOI] [PubMed] [Google Scholar]
- Roberts I., Edwards P., McLelland B. More on albumin. Use of human albumin in UK fell substantially when systematic review was published. BMJ. 1999 May 1;318(7192):1214–1215. doi: 10.1136/bmj.318.7192.1214b. [DOI] [PMC free article] [PubMed] [Google Scholar]
- SHIRES T., WILLIAMS J., BROWN F. Acute change in extracellular fluids associated with major surgical procedures. Ann Surg. 1961 Nov;154:803–810. doi: 10.1097/00000658-196111000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]