Tang Swee Fong
Department of Paediatrics, UniversitiKebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
Fluid resuscitation is an integral part of management of children with shock. The goals of this strategy is to improve physiologic indicators of perfusion and vital organ function. The ACCM-PALS guideline as well as other resuscitation guidelines recommend fluid boluses of 20mL/kg of normal saline in children with shock. A higher morbidity and mortality has been seen in children from low resource countries who received fluid rapid bolusesof 20mL/kg. Furthermore, recent data has suggested that early fluid accumulation in children treated for shock is assosciated with higher PICU mortality. The administration of balanced crystalloids instead of normal saline has also resulted in a lower rate of the composite outcome of death, from any cause, new renal replacement therapy, or persistent renal dysfunction.Despite the widespread use of fluids as part of the resuscitation strategy for shock, it remains unclear the amounts of resuscitation bolus, the rapidity at which these should be administered and also the types of fluid that should be used. These issues are further magnified in children with co-morbidities. The heterogeneity of shock aetiology means that no one recommendation for fluid resuscitation is likely to fit all. Studies looking at whether outcomes will be improved with more modest fluid volumes and earlier introduction of inotropes are currently awaited.
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