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More than 75,000 children in the U.S. alone are affected by septic shock each year.¹ The mortality rate for pediatric septic shock ranges from 9-25% on average but can be as high as 50% for vulnerable populations.^1,2 Fortunately, many of these cases are reversible when early identification enables the start of rapid fluid resuscitation.

However, pediatric patients present unique challenges for rapid fluid resuscitation, including difficult intravenous (IV) access and small IV catheters that are more prone to infiltration.³ Traditional infusion fluid delivery methods, including the push-pull technique, pressure bags, and rapid infusers, fail to account for these challenges and often delay care.⁴

The following case from a pediatric hospital in Arizona demonstrates the effectiveness of a handheld rapid infuser for delivering multiple fluid boluses in a short window to stabilize a pediatric patient in septic shock following a new gastrostomy tube (G-tube) placement.

Case Presentation

A 12-year-old male arrived at the emergency department (ED) one day after having a new G-tube placed. The patient had a history of developmental delay and was nonverbal at baseline. He also had a historical G-tube, but this admission was unrelated.

Upon arrival, the patient was extremely hypotensive, with a blood pressure of 54/41 mmHg, and tachycardic with a heart rate of 120. The patient was also febrile with a temperature of 38.4 degrees Celsius and appeared listless during the exam. Palpation revealed the patient’s abdomen to be firm and distended.

Based on these findings, the treatment team determined the patient was in septic shock, likely due to an issue with the new G-tube site in the abdomen. However, the team agreed that a CT scan was necessary to determine the etiology further. Nurses obtained a 22-gauge peripheral IV line to prepare for fluid resuscitation to stabilize the patient before transport. The patient was also started on norepinephrine at the maximum dose for his age and weight.

Management

The nursing team began fluid resuscitation by administering a 1 L bolus of normal saline (NS) as a gravity drip. Following this bolus, the patient’s vital signs showed no improvement. The medical team ordered additional NS boluses in 500 mL increments to be administered with the LifeFlow handheld rapid infuser with a reassessment of vital signs between each bolus.

The next 500 mL of NS was administered using LifeFlow over approximately three minutes through the peripheral IV. The patient’s shock symptoms persisted after this bolus, and reassessment showed a blood pressure of 65/51 mmHg and a heart rate of 118.

Two additional 500 mL NS boluses were given with LifeFlow over three minutes and two and a half minutes respectively. Assessment after each bolus showed minor improvements to both the patient’s vitals and assessment. He remained hypotensive, but his heart rate decreased to 90.

A fourth 500 mL NS bolus was administered with LifeFlow over two and a half minutes. Following this, the patient’s blood pressure increased to 82/58, and his heart rate further decreased to 83. His mental status remained roughly the same, though the team had difficulty assessing this given his nonverbal baseline. The patient responded to painful stimuli and successfully maintained his own airway without needing supplemental oxygen throughout the process.

Following these interventions, the patient was transported to CT, where scans revealed a perforated bowel. He then underwent emergency surgery to repair the perforation.

Discussion

Rapid reversal of septic shock symptoms to promote adequate perfusion is essential for improving outcomes in pediatric patients. Traditional fluid delivery methods often fail to meet the American College of Critical Care Medicine’s (ACCM) guideline of administering a 20 mL/kg rapid fluid bolus within five minutes.³

Both digital IV pumps and the push-pull technique are too slow to effectively achieve this rate, while the latter is labor intensive and increases contamination risk.^4,5 Traditional rapid infusers require specialized training, are complex to operate, and don’t work well with smaller pediatric patients.   A pressure bag has been shown to speed fluid delivery over gravity, but this technique requires constant re-inflation to achieve adequate flow and it’s difficult to measure how much fluid has been delivered.⁶

In this case, the nurses said that, “LifeFlow allowed us to stabilize this patient faster so that we could get him to CT and figure out what was wrong.”

LifeFlow takes as little as one minute to set up and is four times faster than traditional methods for volume resuscitation through small gauge IV catheters commonly used in children.⁴ This allows providers to quickly reassess the patient and determine whether additional interventions are needed.

When pediatric septic shock patients need rapid fluid resuscitation, traditional methods often fall short. LifeFlow is easy to use and fast to set up, allowing providers to start infusing fluids within seconds and deliver life-saving boluses faster.