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Effect of Restricted Fluid Management Strategy on Outcomes in Critically Ill Pediatric Trauma Patients: A Multicenter Randomized Controlled Trial

Multicenter Studies

Effect of Restricted Fluid Management Strategy on Outcomes in Critically Ill Pediatric Trauma Patients: A Multicenter Randomized Controlled Trial

Trauma Fluid Protocol 3-6-20
Effect of Restricted Fluid Management Strategy on Trauma Outcomes
Review of Fluid Management in Pediatric Trauma Patients
SURG-TRAUMA Appendix 1 - Treatment Algorithm -50
SURG-TRAUMA Appendix 1 - Treatment Algorithm +50

Critically ill trauma patients experience a severe inflammatory response causing a capillary leak syndrome that has been traditionally thought to require aggressive fluid resuscitation. As such, crystalloid fluid administration has been the cornerstone of treatment of most critically ill pediatric trauma patients. Recent prospective adult studies, however, challenge this aggressive fluid management practice, linking high-volume crystalloid resuscitation to increased complications and mortality. No evidence-based standard currently exists to guide management of fluids in pediatric trauma patients, even though fluids are intrinsically involved in their care. We are conducting the first multicenter randomized controlled trial comparing a liberal fluid management strategy to a restricted fluid management strategy in critically ill pediatric trauma patients to determine best practice guidelines in these patients. Our fluid strategies consist of defined resuscitative and diuresis phases, and crystalloid volume administration is determined by physiologic parameters and by patient age and weight. Our primary outcome will be overall incidence of complications, particularly focusing on complications related to respiratory support requirement and lengths of stay in intensive care and for hospitalization. We aim to define an evidence-based fluid algorithm generated by physiologic parameters that can be implemented to improve patient outcomes in pediatric centers throughout the country; this will allow practitioners in a wide breadth of clinical settings to follow clear and concise guidelines for fluid management in critically ill pediatric trauma patients.