To investigate clinical efficacy of limited fluid resuscitation (LFR) in the treatment of children with septic shock (SS) in decompensation stage.

From January 2017 to December 2019, a total of 60 children with SS in decompensation stage admitted to Pediatric Intensive Care Unit (PICU) of Maternity and Child Health Care Hospital of Guangxi Zhuang Autonomous Region were selected into this study. They were randomly divided into observation group (n=30) and control group (n=30) by envelope method. Children in both group were given standardized anti-shock treatment. Patients in observation group were adopted LFR measure and vasoactive drugs to maintain systolic blood pressure above lower limit of normal systolic blood pressure of children at the same age (5th percentile). Meanwhile, patients in control group were adopted active liquid resuscitation (AFR) measure and maintained systolic blood pressure within the typical systolic blood pressure range of the same age (50th percentile). The diastolic blood pressure of patients was maintained at 2/3 of systolic blood pressure in both groups. The arterial blood lactate acid concentration, blood pressure, heart rate, urine volume, oxygenation index (OI), lactate clearance rate (LCR), infusion volume, vasoactive drug dose, mechanical ventilation time, and hospital stay in PICU were statistically analyzed by ANOVA of repeated measurement data and independent-samples t test. Chi-square test was used to analyze age, gender, incidence of fluid overload, continuous blood purification (CBP) implementation rate and 28 d mortality of two groups. The procedure followed in this study conformed to the medical ethics standards in Maternity and Child Health Hospital of Guangxi Zhuang Autonomous Region has been approved by the ethics committee [Approval No. (2017-1)4-16]. Informed consent was obtain from each participant.

①There were no significant difference between two groups in gender, age, arterial blood lactate concentration at admission, severe pneumonia/pediatric acute respiratory distress syndrome (PARDS), myocardial depression and pediatric critical illness score (PCIS) (P>0.05). ② The resuscitation blood pressure in observation group was (77±3) mmHg (1 mmHg=0.133 kPa), significantly lower than that of control group (93±4) mmHg, and the difference between two groups was statistical significance (t=18.441, P<0.001). ③ The infusion volume at 6 and 24 hours after resuscitation in observation group were (69±16) mL/kg and (120±20) mL/kg, respectively, which were significantly lower than those of (95±17) mL/kg and (166±19) mL/kg in control group, and the differences between two groups were statistical significance (t=—5.716, —9.112; P<0.001, <0.001). And dosage of epinephrine and norepinephrine at 24 h after resuscitation in observation group were (151±26) μg/kg and (158±23) μg/kg, respectively, which were lower than those of (201±35) μg/kg and (196± 39) μg/kg in control group. There were also significant difference between two groups (t=—6.210, —4.633; P<0.001, <0.001). ④There were no significant differences between two groups in urine volume, arterial blood lactate acid concentration and LCR at 6 and 24 h after resuscitation between two groups (P>0.05). ⑤The OI and heart rate at resuscitation and 1, 6, 12, and 24 h after resuscitation in two groups showed that, for OI, there was an interaction effect between different treatment measures and time factors (F_{treatment×time}=20.821, P<0.001); for heart rate, there was no interaction effect between different treatment measures and time factors (F_{treatment×time}=0.525, P=0.717). The results of further analysis by fixing time factor showed that OI at 12, 24 h after resuscitation in observation group were significantly higher than those in control group, and the differences were statistical significance (t=2.084, 2.090; P=0.042, 0.041); while the difference of heart rate at each time point between two groups had no statistical significance (P>0.05). The results of further analysis by fixing treatment measures showed that there were significant differences in the overall comparison of OI and heart rate within the observation group (OI: F=1.675, P=0.014; heart rate: F=2.854, P<0.001), and there were also significant differences in the overall comparison within control group (OI: F=1.642, P=0.016; heart rate: F=3.695, P<0.001). ⑥The incidence rate of fluid overload, duration of mechanical ventilation and hospital stay in PICU in observation group were 13.3% (4/30), (8.2±0.8) d and (8.2±0.8) d, respectively, which were significantly lower than those of 36.7% (11/30), (6.8 ± 1.2) d and (10.2 ± 1.7) d in control group, and the differences between two groups were statistical significance (χ²=4.356, t=—4.933, —5.407; P=0.037, <0.001, <0.001).

LFR can rapidly improve the oxygenation of children with SS in decompensation stage, shorten mechanical ventilation duration and hospital stay in PICU, and have no significant affect on 28 d mortality. Because sample size in this study is relatively small, and it is a single-center study, it still needs to be further confirmed by large-sample, multicenter, randomized controlled trials.