Abstract 197: Rapid Pediatric Fluid Resuscitation: A Randomized Controlled Trial Comparing the Efficiency of Two Provider Endorsed Manual Fluid Resuscitation Techniques
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abstract
Introduction:
Manual syringe techniques are commonly used by Health Care Providers (HCPs) to accomplish fluid resuscitation for children in shock.
Objectives:
We sought to determine which of two commonly practiced manual fluid resuscitation techniques, Disconnect-Reconnect (DRT) versus Push-Pull (PPT), yielded a higher rate of fluid administration.
Hypothesis:
We hypothesized that a difference in fluid resuscitation rate would exist between DRT and PPT.
Methods:
A 16 participant randomized crossover trial was conducted at McMaster Children’s Hospital in Hamilton, Canada. Consenting HCPs were oriented to the experimental setup, which involved a non-clinical model of a 15 kg toddler in decompensated septic shock. The model incorporated a 22-gauge catheter, with administered fluid draining into a 1-litre graduated cylinder. Following randomization, subjects completed a brief standardization procedure and then were asked to rapidly administer 900 mL (60 mL/kg) of 0.9% normal saline to the simulated child. Between DRT and PPT, a 30-minute washout period was enforced. All testing was video recorded, with data extracted from trial videos by two blinded outcome assessors. The primary outcome of a difference in total fluid administration rate was analyzed by paired t-test.
Results:
Total fluid administration rate (mL/second) significantly differed between the two techniques, with a mean difference of 0.15 [95% CI 0.05; 0.25] (p=0.005). Mean (sd) fluid administration rates were DRT, 1.77 (0.145) and PPT, 1.62 (0.226). A change in fluid administration rate occurred over the intervention for DRT, F(1,15)=2316.36 (p<0.001) and PPT, F(1,15)=806.04 (p<0.001). Pairwise comparisons indicate that DRT Rate 1, 1.63 (0.143) significantly differed from Rate 2, 1.83 (0.176) and Rate 3, 1.88 (0.180); (p<0.001). PPT Rate 1, 1.62 (0.223) and Rate 2, 1.58 (0.237) did not differ, but Rate 2 significantly differed from Rate 3, 1.67 (0.265); (p=0.003). HCPs encountered technical issues more frequently when performing PPT versus DRT. No catheter dislodgements occurred. HCP self reported fatigue did not differ between DRT and PPT (p=0.755).
Conclusions:
Use of DRT resulted in a faster rate of fluid administration than PPT in a simulated pediatric resuscitation scenario.
