Intubation and mechanical ventilation, although potentially necessary
during the course of treatment, may initially impair venous return in an
already hypovolemic child, worsening their hemodynamics. Non-
invasive therapies, such as high flow nasal cannula or CPAP, have
been shown to improve functional residual capacity, while allowing for
initial resuscitation to start.[7,10] Mechanical ventilation may indeed be
necessary early in the course of treatment. Proceed with intubation, if
necessary, once the initial volume resuscitation and inotropes have
been started.
5 - 15 minutes: Initiate fluid resuscitation and start broad
spectrum antibiotics. Start with 20 ml/kg boluses, to at least 60
ml/kg, until perfusion has improved or signs of volume overload
develop, limiting further aggressive fluid loading. Early sings of
volume overload include hepatomegaly and rales and if present,
further boluses should be limited. If more support is needed and
another IV is present, add an inotrope, treat hypoglycemia and
hypocalcemia.
Of note, if sepsis is suspected, fluid resuscitation should start even
without signs of hypotension. Pediatric patients compensate for
hypotension very well initially, using tachycardia and peripheral
vasoconstriction as compensatory mechanisms. Once hypotension