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Sepsis among pediatric patients is a common cause of morbidity and mortality and represents an urgent challenge for providers in emergency and critical care settings. Globally, an estimated 1.2 million cases of sepsis occur each year in pediatric patients with a mortality rate of 9-20%.¹ Rapid identification of symptoms and initiation of antibiotics and fluid resuscitation – to maintain adequate tissue perfusion—is essential for the early reversal of septic shock.

Current American College of Critical Care Medicine (ACCCM) pediatric shock reversal guidelines suggest administering a crystalline fluid bolus of 20 mL/kg over five minutes. Following the bolus, vital signs and perfusion should be reassessed. If improvement is not noted, additional boluses of 20 ml/kg may be administered until perfusion improves or signs of fluid overload develop.  Unfortunately, common methods of fluid delivery, including the popular push-pull technique, frequently fall short of achieving timely and effective resuscitation as outlined by current guidelines.²

The following case from a pediatric hospital in New Jersey demonstrates the effectiveness of using a novel handheld rapid infuser to rapidly initiate fluid resuscitation in a patient presenting with septic shock and deliver multiple boluses in a short window.

Case Presentation

A 22-month-old patient with no prior medical history arrived in the emergency department with complaints of respiratory distress and decreased oral intake. Upon examination, the patient was also found to be tachycardic and listless with a blood pressure of 120/92 mmHg. The patient’s capillary refill time was roughly four seconds upon arrival and the child appeared to be moderately to severely dehydrated.

Following an assessment, the patient was diagnosed with pneumonia. Based on the facility’s pediatric sepsis protocol, a diagnosis of septic shock was also made, prompting the team to begin rapid fluid resuscitation efforts. The medical team was unable to quickly obtain intravenous access due to the patient’s poor hydration status, so intraosseous (IO) access was established to avoid delaying the start of fluid resuscitation.

Management

Based on the hospital’s sepsis protocol, a 20 ml/kg bolus of 0.9% normal saline was ordered, and the infusion was started using the LifeFlow rapid infuser. The nurse administered the bolus over approximately four minutes via the IO route.

Following the bolus, the patient’s heart rate, respiratory status, capillary refill time, and mental status were all reassessed with an unsatisfactory response. The nurse then used the LifeFlow device to administer two additional 20 ml/kg boluses of normal saline. Each bolus was administered over roughly four minutes via IO with an additional round of assessments performed after each one.

Following the third bolus, the patient’s heart rate decreased to a normal range and the child’s capillary refill time decreased to less than three seconds. The patient also became appropriately agitated for their age, signaling an improvement in mental status from the previous state of listlessness.

The patient was then placed on BiPap due to continued respiratory distress and admitted to the facility’s pediatric intensive care unit (PICU) before eventually being discharged home on supportive care.

Discussion

Rapid identification of septic shock symptoms and prompt resuscitation are crucial for improving outcomes in pediatric patients. Traditional fluid infusion methods are often inadequate. IV pumps and push-pull are too slow and push-pull is labor intensive and prone to contamination risk. ³ Traditional rapid infusers often alarm or don’t work well with small, pediatric patients.

In this case, the nurses said the LifeFlow rapid infuser was, “Much easier to use than traditional push-pull, less painful on the hands, and the system is closed which decreases the likelihood of infection.”

“I was able to take one item out of the package and start pushing fluids on this child immediately. Traditional push-pull requires multiple items that have to be put together and found. While this may seem trivial, every minute is precious with a baby this sick,” the nurse added. “I love the LifeFlow device and can’t imagine not having it. We’ve saved many children with this device.”

When septic pediatric patients need rapid fluid resuscitation, traditional methods are often inadequate. In contrast, LifeFlow’s speed and  simple set-up and one-handed operation allow providers to begin infusing fluids within seconds and deliver needed boluses much faster than other common methods.