Pediatric Sepsis/Septic Shock Fluid Resuscitation (SSC) — free guideline decision tool

This tool applies the Surviving Sepsis Campaign 2020 pediatric guideline to fluid resuscitation in septic shock, varying the bolus strategy by availability of intensive care and presence of hypotension.

With ICU: 10–20 mL/kg boluses, cumulative cap 40–60 mL/kg; no ICU + hypotension: cap 40 mL/kg; no ICU + no hypotension: no bolus, start maintenance fluids. Epinephrine or norepinephrine first-line; antibiotics ≤ 1 h (shock) or ≤ 3 h (no shock).

Use in children with sepsis or septic shock to set the first-hour fluid strategy and the timing of vasoactive drugs and antibiotics.

Each bolus is followed by reassessment (heart rate, perfusion, hepatomegaly, rales, work of breathing) and stopped immediately at any sign of fluid overload. Where intensive care is unavailable and there is no hypotension, the guideline strongly recommends against bolus fluids, favoring maintenance fluids. Epinephrine or norepinephrine — not dopamine — is the first-line vasoactive agent for fluid-refractory shock, titrated to perfusion and blood pressure.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: Intensive care available (locally or by transfer) ICU available, Hypotension present Hypotension present, Weight (to calculate bolus volume, optional) 15 kg → Result: Resuscitation Bolus allowed (cap 60 mL/kg)（Resuscitation strategy: ICU available: fluid boluses allowed in the first hour, 10–20 mL/kg each, cumulative cap 40–60 mL/kg; reassess hemodynamics after each bolus, titrate to cardiac-output measures, stop at any sign of fluid overload (hepatomegaly/rales/increased work of breathing), Bolus volume (for 15 kg): Each 10–20 mL/kg = 150–300 mL; first-hour cumulative cap 60 mL/kg ≈ 900 mL, Vasoactive drugs: Fluid-refractory shock: epinephrine OR norepinephrine first-line (do not use dopamine first-line); titrate to perfusion/blood pressure） Inputs: Intensive care available (locally or by transfer) No ICU, Hypotension present No hypotension, Weight (to calculate bolus volume, optional) 15 kg → Result: Resuscitation No bolus · maintenance fluids（Resuscitation strategy: No ICU + no hypotension: do not give fluid boluses (strong recommendation), start maintenance fluids directly; monitor closely, manage as above if hypotension/shock develops, Vasoactive drugs: Fluid-refractory shock: epinephrine OR norepinephrine first-line (do not use dopamine first-line); titrate to perfusion/blood pressure, Antibiotic timing: Septic shock: empiric broad-spectrum antibiotics as soon as possible, within ≤ 1 hour; sepsis without shock: within ≤ 3 hours after evaluation (sooner if shock develops)）