Among children with septic or severe infection shock, those in whom resuscitation is attempted via fluid bolus may have a higher mortality rate at 48 hours compared with children who do not receive a fluid bolus, suggested findings of a systematic review recently published in Shock.

Previous research has shown conflicting results as to whether fluid bolus administration in children with septic or severe infection shock as an early intervention was helpful or harmful, with mortality rates in such children after fluid bolus ranging from 8% to 41%.

In the current study, investigators in China conducted a systematic review and meta-analysis to assess the mortality rates after fluid bolus in children with septic or severe infection shock. The primary outcome was overall mortality associated with shock. Secondary outcomes included the incidence of mortality at 48 hours and 4 weeks.


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A total of 19 studies involving 9321 pediatric patients with septic shock or severe infection shock between 1999 and 2020 were assessed. The majority of the studies were conducted in India (n=6), Kenya (n=5), and Vietnam (n=3). Nearly all (18) studies reported mortality at 48 hours, with only 1 reporting mortality in the fluid bolus group. Most studies included patients with septic shock as well as those with general shock, malaria shock, dengue shock, or malnutrition shock.


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The investigators evaluated 17 studies with reports of mortality at 48 hours. Compared with patients with fluid bolus, there was a decreased rate of mortality among patients who did not have fluid bolus (risk ratio [RR], 0.74; P <.01) and no heterogeneity was reported. The subgroup of patients with general shock did not have statistically significantly different values (RR, 0.79; P =.07).

For patients with malaria shock, there was a significant difference in mortality rates among patients with and without fluid bolus, with better outcomes for patients without bolus (RR, 0.65; P =.01).

In the 2 studies that reported mortality at 4 weeks, pooled results suggested that patients with no bolus were more protected against 4-week mortality than patients with bolus (RR, 0.71; P <.01).

Overall, the analysis “showed no difference on mortality after using fluid bolus in pediatric patients,” the investigators stated. For the secondary outcome of mortality at 48 hours, the group with no bolus showed decreased mortality compared with the bolus group, especially in children with malaria, they added.

Study limitations included the variations in sample sizes across the studies reviewed, variations in the definitions of shock across the 19 studies, and the fact that only 2 investigations reported mortality at week 4. The investigators concluded that “meta-analysis with more long-term follow-up and larger sample size studies are warranted to address the conclusion in the future.”

Reference

Yue J, Zheng R, Wei H, et al. Childhood mortality after fluid bolus with septic or severe infection shock: a systematic review and meta-analysis. Shock. 2021;56(2):158-166. doi:10.1097/SHK.0000000000001657

Every influenza season brings with it uncertainty about what strain will predominate and how severe it will be. While much of the world still is focusing on COVID-19, the potential for another serious influenza season can’t be ignored, and the strain on the health care system of 2 epidemics could be severe.1

As the SARSCoV-2 virus continues to spread across the country, the 2020-2021 influenza season will be particularly challenging.1 Recent influenza seasons have been particularly serious: 2017-2018 was one of the deadliest in decades, with an estimated 61,000 deaths, and 2018-2019 was one of the longest flu seasons, lasting 21 weeks.2

The 2019-2020 influenza season was on a trajectory to be particularly severe, especially for children because of a high prevalence of influenza B cases.3 However, the season ended 5 to 6 weeks earlier than anticipated after control measures were put in place to prevent COVID-194; even with the shortened season, the Centers for Disease Control and Prevention (CDC) estimated 34,157 deaths, which was on par with the number of cases from 2018-2019.2,3 

Although influenza viruses cannot be controlled directly, there are several measures that can be taken to help mitigate the severity of the influenza season.

Prevention

In March 2019, the World Health Organization (WHO) announced a Global Influenza Strategy for 2019-2030 aimed at “protecting people in all countries from the threat of influenza.”5 The goals include the prevention of seasonal influenza, the control of spread from animals to humans, and preparation for the next influenza pandemic.5  

Many pandemic control measures learned by studying the 1918, 1957, 1968, and 2009 influenza pandemics are being used for COVID-19 and will continue to be used during the influenza season this fall.  However, as stay-at-home orders are lifted and children return to school, these measures may not be effective at preventing a serious influenza season. 

It is especially important for everyone, especially those at high risk for influenza and COVID-19 infection, to receive an influenza vaccination this season and use nonpharmaceutical prevention strategies, such as frequent hand hygiene, masking, voluntary home isolation for ill people, respiratory etiquette, and frequent cleaning of surfaces.  These measures should be followed year-round by everyone, especially during influenza season, to limit the transmission of infection.6 These interventions are most effective when implemented in combination, for example, hand hygiene and wearing a face covering.7

This article originally appeared on Clinical Advisor