Effect of Giving Reduced Fluid in Children After Trauma

Aggressive fluid resuscitation has been the cornerstone of early post-operative and trauma management for decades. However, recent prospective adult studies have challenged this practice, linking high volume crystalloid resuscitation to increased mortality, cardiopulmonary, gastrointestinal and hematologic complications. A retrospective study the investigators recently performed at their quaternary-care children's hospital echoed these results. High quality prospective data is necessary to determine best practice guidelines in our pediatric surgery and trauma patients.

Currently, no standard exists to guide management of crystalloid fluid administration in trauma patients. Both liberal and restricted strategies are in use, dependent on physician discretion. The investigators propose the first randomized controlled trial (RCT) comparing a liberal to a restricted fluid management strategy in critically ill pediatric trauma patients. The objective of this comparative effectiveness study is to conduct a multicenter (around 10 sites) randomized controlled trial (RCT) to determine whether liberal or restricted fluid administration leads to better outcomes in these patients.

Inclusion criteria

• Trauma patients older than 6 months and younger than 15 years admitted to the pediatric intensive care unit (PICU)
• Patients admitted to the PICU directly from the Emergency Department (ED)
• Patients admitted to the PICU from the operating room (OR)
• Patients transferred to PICU from outside facility ED (need to have been in ED 12 hours or less)

Exclusion criteria

• Patients transferred to PICU from outside PICU or inpatient floor
• Patients transferred to PICU from outside facility ED if >12 hours
• Patients expected to be discharged from the PICU within 24 hours
• Patient with congenital heart disease as defined by a congenital cardiac defect requiring surgery or medication
• Patient with diagnosis of chronic cardiac condition (e.g. hypertension, cardiac arrhythmia)
• Patients with chronic kidney disease as defined by an abnormality of kidney structure or function, present for more than 3 months, with implications to health
• Post-operative transplant, cardiac, and neurosurgical patients
• Patients with traumatic brain injury
• Patients with any disease that may affect baseline blood pressure and heart rate (endocrine disorders, certain genetic disorders, mitochondrial diseases)
• Hypotension requiring vasopressor therapy
• If massive transfusion protocol initiated