Predictive Mini-bolus Fluid Responsiveness in Pediatric Septic Shock
Condition: Severe Sepsis or Septic Shock in Pediatric Intensive Care Unit
MeSH terms: Sepsis; Shock, Septic; Shock
Study type: Interventional

Summary: 
      Severe sepsis and septic shock remain of particular gravity in children with a current
      mortality of about 20 % , despite the international prevention campaigns " survival sepsis
      campaign ". Septic shock associates a macrocirculatory and a microcirculatory dysfunction.
      The volume expansion remains the treatment of severe sepsis at the initial phase supplemented
      by the use of vasopressors and / or inotropes. Nevertheless , it is essential to predict the
      fluid responsiveness after volemic expansion because fluid overload is associated with an
      increased morbidity in children. In studies , the volume expansion is considered effective if
      it allows an increase in cardiac output of more than 15 % compared to the basal level.
      However, their conditions of use remain very restrictive and not applicable to most of our
      patients ( tidal volume ≥ 7ml / kg , PEEP sufficient , absence of cardiac arrhythmia and
      effective sedation ) . To date , no index can be used for all patients with invasive
      mechanical ventilation.

      It therefore seems appropriate to develop new tests to predict the response to volume
      expansion in children with septic shock hospitalized in pediatric intensive care.

      A recent study has validated a test to predict the response to volume expansion in adults:
      injection of a mini-bolus of 50 ml of saline over 10s.

      The aim of the study is to evaluate the effect of mini bolus fluid to predict response to
      fluid expansion in pediatric septic shock.
    

Detailed description: 
      Severe sepsis and septic shock remain of particular gravity in children with a current
      mortality of about 20 % , despite the international prevention campaigns " survival sepsis
      campaign " . Septic shock associates a macrocirculatory and a microcirculatory dysfunction.
      The volume expansion remains the treatment of severe sepsis at the initial phase supplemented
      by the use of vasopressors and / or inotropes . Nevertheless , it is essential to predict the
      fluid responsiveness after volemic expansion because fluid overload is associated with an
      increased morbidity in children . In studies , the volume expansion is considered effective
      if it allows an increase in cardiac output of more than 15 % compared to the basal level .
      However , their conditions of use remain very restrictive and not applicable to most of our
      patients ( tidal volume > 7ml / kg , PEEP sufficient, absence of cardiac arrhythmia and
      effective sedation ) . To date , no index can be used for all patients with invasive
      mechanical ventilation .

      It therefore seems appropriate to develop new tests to predict the response to volume
      expansion in children with septic shock hospitalized in pediatric intensive care.

      A recent study has validated a test to predict the response to volume expansion in adults :
      injection of a mini-bolus of 50 ml of saline over 10s.

      The aim of the study is to evaluate the effect of mini bolus fluid to predict response to
      fluid expansion in pediatric septic shock.
    

Intervention name(s): Mini-bolus
Intervention type(s): Procedure
Intervention description(s): First injection of 2ml/kg (saline solution)
Second injection of 18ml/kg (saline solution)
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Mini-bolus challenge; fluid responsiveness; volemic expansion; pediatric septic shock; severe sepsis; microcirculation