Second, while use of a crossover design may have been preferable, with 4 intervention groups, we felt that use of this design would negatively impact on feasibility and increase the risk of participant dropout. We are satisfied that participants’ characteristics appear well balanced across the groups in our study. Thirdly, no catheter dislodgement events were recorded in our trial.

It is possible that features attributable to our model had a protective effect against catheter dislodgement, although this Inhibitors,research,lifescience,medical was indeed possible and occurred during pilot testing. In this context, it is notable that only 1/57 subjects in the clinical trial Inhibitors,research,lifescience,medical performed by Stoner et al. experienced a catheter failure [9]. Finally, our trial protocol did not strictly adhere to ACCM guideline insofar as “patient” reassessments between each 20 mL/kg bolus are recommended [4]. In our experience, these reassessments often do not slow HCPs from administering fluid where ongoing resuscitation in required Inhibitors,research,lifescience,medical and such assessments are often done concurrently. Although our study was conducted in the non-clinical

setting, we had typical health care providers perform rapid fluid administration as they would under resuscitative conditions. The model incorporated an IV catheter and so resistance to fluid flow was as it would be in the clinical setting. Further, infants and children with decompensated shock, as in our clinical vignette are typically lethargic and so patient movement may not be all that dissimilar to

our model. We therefore 17-AAG order believe that our findings can likely Inhibitors,research,lifescience,medical be cautiously extrapolated to the clinical setting. Our conclusions, and any other optimizations to be made in rapid fluid resuscitation relate to statistically significant differences in the order of seconds to minutes. Therefore, ultimately demonstrating whether Inhibitors,research,lifescience,medical improvements in pediatric fluid resuscitation performance have an impact on patient important outcomes like morbidity and mortality may be difficult. Nonetheless, observational studies have provided the basis for current goal-directed ACCM benchmarks, [16,17] and subsequent prospective Cell press studies have shown morbidity and mortality benefit with adherence to these [18,19]. Morbidity and mortality related to pediatric septic shock has dropped significantly in recent decades – owing in part to improved recognition and aggressive management, of which fluid resuscitation is currently considered a critical component [20,21]. While studies such as the FEAST trial [22] have begun to raise questions regarding the role and extent of fluid resuscitation in the treatment of septic shock, the purpose of our study was not to challenge current ACCM guidelines, for which support has recently been reaffirmed [23].