Given that DFTB18 was held in Melbourne it was important to highlight the work of PREDICT (the Paediatric Research In Emergency Department International Collaborative)* This talk, by Elliot Long, centred around his work on the role of fluids in the septic child.
Following the recent online discussion around the FiSH pilot study and the potential harms of fluid boluses demonstrated in the FEAST trial it would seem apropos to release this talk from DFTB18. We seem to have a knee jerk reaction to give a fluid bolus in septic children but should we?
The FEAST trial was published in 2011 and has had very little impact on what we do in the Western setting. What we think of as a low fluid state – dehydration – is not the same as what our colleagues in Africa would view as sepstic. This is something we will explore at a later date.
So if we can’t rely wholly on our history and our physical exam is often equivocal then what other methods are there? Elliot Long likes to use ultrasound to guide his management.
He looks at the lungs looking for B lines with the linear probe.
He then looks at the IVC to see if it is plump or underfilled with the phased array probe.
And finally he looks at the heart itself, with the phased array probe, to see if it is hyperdynamic.
Elliot and the PREDICT group recently published some of their work looking at the fluid bolus therapy in septic children. This prospective observational trial looked at the response to a fluid bolus in 41 sick children. Interestingly the mean blood pressure dipped after a fluid bolus and took up to 60 minutes to return to baseline.
*COI – Both Ben and Andy have done or are doing work under the auspices of PREDICT
This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story‘ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families.
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