Fluid Resuscitation

Fluid Therapy

• Administer a LR or NS fluid bolus of 10-20 mL/kg if shock present
• Monitor response to fluids (Vital Sign Targets and Clinical Goals for Initial Resuscitation)
• Tailor fluid therapy to the individual patient
• Consider 5-10 mL/kg boluses every 10-20 minutes for patients with the following:
  • Known cardiac dysfunction
  • Pulmonary edema
  • Severe anemia
  • Renal dysfunction (creatinine clearance < 60)

Note. LR and ceftriaxone are incompatible. When administered together, there is a risk of precipitation in the tubing. If two IV sites are unavailable to run both separately, contact the provider to discuss prioritizing fluid versus antibiotics. 

Rapid Fluid Infusion Techniques

• Administer via Push-Pull Technique or Manual Syringe, if < 50 kg
• Use Push-Pull Technique if ≥ 50 kg and Pressure Bag or Rapid Infuser is not available
• Use Pressure Bag or Rapid Infuser (if available), if ≥ 50 kg
• For patients < 16 kg, the pump may be used

Monitoring/Assessment

• Continue rapid volume infusion as needed, titrate to goal clinical parameters
• Initiate vasoactive infusion if poor response to fluid therapy following 40-60 mL/kg (or sooner due to signs of fluid overload or myocardial dysfunction)
• Development of pulmonary crackles, hepatomegaly, CVP > 12 (>15 if on PPV) in absence of hemodynamic improvement with bolus suggests limited benefit of further fluid therapy