ArticleWorld journal of clinical pediatrics2026
Early inotropic support without fluid bolus
Article in World journal of clinical pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe current 2020 surviving sepsis guideline recommends fluid boluses of 10-20 mL/kg/bolus up to 40-60 mL/kg, but recent studies showed better outcomes when fluid boluses were restricted.
aimTo analyze the outcome of initial resuscitation of septic shock without giving fluid bolus and early initiation of inotropes.
methodsIn this open label, randomized controlled clinical trial conducted at the Pediatric Emergency Medicine unit of a tertiary care hospital in central India, patients aged 1 month to 14 years who were hospitalized for septic shock were randomly allocated (1:1) to receive either inotropes (Group I) or fluid bolus as per surviving sepsis guideline (Group F). We analyzed the primary endpoint (either the resolution of shock or the patient's clinical status at 1 h from the initiation of resuscitation, whichever occurred first) by the intention-to-treat. Both the groups were compared in terms of reversal of shock, the mean time for reversal of shock, adverse effects including mortality at 48 h, and overall mortality.
resultsOut of 119 patients with septic shock, 49 were included in the final analysis (24 patients in Group I and 25 patients in Group F. 16/49 (32.65%) patients had compensated shock, and 33/49 (67.35%) had hypotensive shock. During the initial resuscitation phase, shock resolved in all (100%) of the patients in Group I. In Group F only in 19/25 (76.00%) patients experienced resolution of shock. The mean time of resolution of shock was significantly shorter in Group I (83.98 + 42.02 min) compared with Group F (116.72 + 41.67 min,
conclusionThe use of fluid boluses in pediatric septic shock is dubious and contributes to fluid overload. The management of septic shock in children involves the use of adjuncts such as bedside ultrasound, early inotropes, and restricted and well-regulated fluid boluses.
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