Fluid Overload in Children with Severe Sepsis and Septic Shock

Abstract

Fluid therapy is one pillar of the treatment of septic shock, however, a hydric≥10% of the weight or Fluid Overload (FO>10%) is associated with poor hospital outcomes. The present study aims to determine the FO in patients with septic shock, and its main associations in terms of mortality and morbidity. An observational and descriptive study was conducted in 49 hospitalized children with septic shock in the PICU of the Manuel Ascencio Villarroel Children’s Hospital (MAVCH); The patients were divided into two groups according to the FO>10% (22 patients) and<10% (18 patients), for their descriptive analysis we included comparison of means and calculation of the OR. Regarding the water requirements, we observed that the group with FO>10% a mean of 5681ml; while in the group with ISCH<10% the mean was 3297.8ml (p=0.19) during first 72 hours, showing greater overload with the administration of colloids and blood products (p=0.02, p=0.004). Regarding hospital outcomes, was found morbidity associated with FO>10% (respiratory dysfunction, vasopressor requirement and renal replacement therapy); The length of hospitalization and FO were not different in groups (p=0.60), but there was higher mortality of patients with FO>10% (p=0.01, OR: 5.57 IC95% 1.4-21.8). Fluids therapy of in the patient with septic shock constitutes one of the first-line hemodynamic treatments, however in limited resources settings, overload should be avoided, mainly due to associated morbidity during the first 72 hours.