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Fluid Resuscitation for Pediatric Trauma Patients?

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Fluid Resuscitation for Pediatric Trauma Patients?
Pamela Bucaro, MS, RN, PCNS-BC, CPEN and Lisa Schwing, RN, Dayton Children's Hospital, Centerville OH

Objective: Evidence-Based Project: Fluid Resuscitation for Pediatric Trauma Patients? Purpose: The American College of Surgeons (ACS) challenged our pediatric trauma facility to consider permissive hypotension for pediatric trauma patients, as this practice has evidence to support its use in adult trauma resuscitation. Therefore, an Evidence-Based practice team created the following PICOT question, �In pediatric trauma patients, how does rapid bolus of crystalloids compared to routine maintenance fluids affect patient stability while in the emergency department?� Design: An evidence-based, pediatric quality assurance project Setting: An ACS verified level II pediatric trauma center location - Midwest. Participants/Subjects: Pediatric trauma patients less than 18 years of age. In addition, limited literature was reviewed for trauma patients less than 55 years of age.
Methods: The Advancing Research and Clinical Practice Through Close Collaboration (ARCC) model, including clinical inquiry, PICOT question development, search strategy, evaluation was used resulting in EBP recommendation. Results/Outcomes: Limiting fluid can be detrimental, particularly in pediatric patients with traumatic brain injury. Fluid resuscitation of 60 ml/kg of isotonic fluids for pediatric patients in hypovolemic shock decreases morbidity and mortality. For uncontrolled hemorrhagic shock in pediatric patients, more studies are needed. Fluid boluses for pediatric patients who are hemodynamically stable were related to increased risk of ascites, pleural effusion and hemodilution. Implications: Current evidence does not support permissive hypotension in pediatric trauma patients suffering from shock. Evidence does suggest that fluid boluses for pediatric trauma patients that are hemodynamically stable may increase complications related to fluid overload.
Objective: Discuss the evidence supporting permissive hypotension in pediatric trauma resuscitation.Objective Content: I. Evidence related to permissive hypotension in pediatric trauma patients A. Literature supports permissive hypotension in some studies of adult trauma patients. B. Limiting IV fluid resuscitation in hemodynamically unstable pediatric trauma patients can be detrimental. 1. Traumatic brain injury C. Providing IV fluid resuscitation in pediatric trauma patients that are hemodynamically unstable 1. 60ml/kg bolus a. Decrease morbidity b. Decrease mortality D. Fluid resuscitation (bolus) in pediatric trauma patients that are hemodynamically stable can contribute to 1. Ascites 2. Pleural effusion 3. Hemodilution.


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