Rapid Vs Standard Intravenous Rehydration In Pediatric Gastroenteritis: A Review

The Title and Abstract

Discuss about the Evidenced Based Health Research and Nursing Research.

Gastroenteritis refers to the short-term illness that is caused by the infection of the digestive system. One of the symptoms of gastroenteritis is inflammation of digestive system (Allen, et al., 2014). Other symptoms are vomiting, abdominal cramp and diarrhea. Main reasons of the pediatric gastroenteritis are virus, bacterial toxins, particular chemicals, bacteria and specific drugs.

The aim of the assignment is to review a quantitative article “rapid versus standard intravenous rehydration in pediatric gastro enteritis: pragmatic blinded randomized clinical trial.” The structure of the study and sample size of the paper is reviewed. Moreover, the appropriateness of data collection and data analysis are discussed with the findings.

From the title of the paper, the objective is very clear. The main aim of the paper is to determine that in between the rapid and standard intravenous rehydration, which one provides better results in developing hydration and the clinical outcomes. This is done during the administration of medication in children with the gastroenteritis.

The article showed that in the public health, gastroenteritis has major importance. In case of children, the most appropriate process of rehydration is the oral rehydration. Moreover, the paper stated that in case of many children, the intravenous rehydration is given those supplies to the overcrowding emergencies department.

However, the title of the research paper is matching with the text. The aims and objectives were stated clearly. From the title, the readers can get an idea about the text. In the abstract of the research paper, the researcher stated about the objective, design setting, participants, intervention, main outcome measures, results and conclusion. In the abstract section, the researcher gave a clear idea about the research design. He selected 226 children who are in between three months to eleven years. He selected a randomized sample based on the inclusion and exclusion criteria.

The abstract stated the intervention process in short that is about which process in maintained during the administration of medication. The researcher showed the primary and secondary outcome measures in the abstract section. In the result, he showed that 112 children among the 226 were standardized and 114 were unintended for the rapid rehydration. However, no noticeable difference is seen between the randomized and standardized sample. To make difference in result, the weight, baseline pH and baseline dehydration score were changed, which did not differ from the previous result (Lenzi, et al., 2014). In the conclusion of the abstract, the researcher showed that there is no effective result in between the standard and rapid intravenous rehydration.

Structuring the Study

The motivation of the study is demonstrated via the literature review. In the literature review section, the researchers cited the current and relevant information. However, the references, the authors used are not very recent. Freedman, Parkin, Willan, and Schuh (2011) stated that in case of the citation the authors should select the recent references that are not older than ten years.

In the research article, the authors did not show the research gaps that should be stated. However, the researcher has compared the study with other studies that provided some beneficial outcomes. However, the paper has various gaps. The authors should be careful during sampling and maintain the inclusion and exclusion criteria. Moreover, proper sampling technique should be maintained.

The researchers have investigated the family members of the patients. They need to investigate the doctors and nurses to gain more information (Freedman, et al., 2014). However, this is not done in the research paper, which is a gap of the paper. The researcher needs to set the hypothesis to make the objective clear. However, the researcher has shown the interest to test the difference in between the groups.  

The strength of the paper is that the author has described the sample clearly. The authors chose a large sample size of the patients that help in the study. However, the researcher should include the parents of the patients. He selected 226 children who are in between the age group of three months to eleven years. The sample size was selected base on the inclusion and exclusion criteria. The researcher excluded the children whose age was less than 90 days. They mainly surveyed in the hospitals of Canada. The surveyed was done in between 2006 December to 2019 April (Kinlin, Bahm, Guttmann, & Freedman, 2013). For the research purpose, mainly the emergency departments for the sick children are chosen. The researchers chose the hospitals of Toronto, Canada. The researcher chose only those children who are eligible for the administration of intravenous rehydration in North America. The researcher selected those children who did not respond to the oral rehydration process to reduce the dehydration secondary to gastroenteritis and those who responded to the rehydration process.

The dehydration as the clinical dehydration scale score that is >three (Allen, et al., 2016). He put a table to define the dehydration scale that can be used for the children who are suffering from gastroenteritis. However, the sample is very large therefore; it took more time to analyze. They took both the result of before and after the treatment. They collected the patient history form the hospitals for survey with the concern of the parents of the children. They excluded the patients and parents who have language problem to avoid the language barrier. They excluded those people also who cannot be contacted digitally that is via telephone or email. They selected the sample of vomiting, hypotensive, hypertensive tendency reports and surgical reports to analyze them for their study (Xu & Rieder, 2014). They did not collect the normal biochemical results, as these variables are not helpful for their research. They did not keep the records of the excluded patients as a result the biasness happened.

The Sample

The researcher chose the survey method to collect the data from the sample. The reason of selecting this method is that the sample size was very large and the patients were in between three months to eleven years who could not state their problems clearly. The researchers collected the data from various hospitals of Toronto, Canada and North America. The patients were allotted in 1:1 ratio for the treatment purpose with the standard or rapid intravenous rehydration (Freedman, Sivabalasundaram, Bohn, Powell, Johnson, & Boutis, 2011). The data are described adequately and clinical dehydration scale is used to measure the data. The hospitals for the sick children are the main origin of the measurement scale. However, Maitland, et al., (2011) mentioned that the four-item scale has shown the strong inter rater reliability. Therefore, the usage of the scale is appropriate. The validation showed that this is correlating with the length of the staying. This is necessary for the intravenous rehydration. However, the data collection showed that it is used in two departments of hospitals that is the emergency department. It needs to mention that the data collection method is effective for the study and provide effective results.

The study has discussed the ethical issues that are they did not study the children who have the cardiovascular problems. Moreover, the repeated electrolyte results are excluded due to the ethical issues. However, the researcher mentioned that the study sponsored did not play any role in the data collection method. Moreover, they did not take part in the analysis or interpretation method. The researcher activities were not dependent on funding score. The researcher team restricted the access of the data to maintain the ethics of the research (Qazi, et al., 2014). The researcher discussed the ethical issues.

The descriptive statistics are reported and the non parametric test were used to analyze the data. This is done to check the appropriateness of the levels of measurement of each level. Before the randomization, the participants that are the children are given the oral rehydration treatment. As per the study, the caregivers gave oral rehydration of 5 mL via a syringe in every 5 minutes. The manifestation of infusion pump build up was identical for all of the children. As per the data analysis result, 50 mL of three injections were connected with two 1 mL of 0.09% saline bags. One port burette was set to control the infusion rate. The children received either the 20 mL/kg or the 60 mL/kg saline infusion. The 20 mL/kg is the standard and 60 mL/kg is the rapid saline infusion (Manfredi, Bizzarri, & de’Angelis, 2013). For the statistical analysis, the protocol of deviation is maintained. To analyze the data, the researcher selected the SAS software. This software helped both for the primary and secondary outcomes. Therefore, the SAS software plays very significant role for the data analysis.

Data Collection

For the primary outcome, the researcher used the 5% significance level; on the other hand, for the secondary outcome the researcher used the 1% significant level. From study protocol, the sensitivity analysis excluded the patients. For the primary and secondary analysis, the researcher used the Fisher’s exact test for examining the differences in primary and secondary outcomes. With the logistic regression model, the rehydration at every two hours and the prolonged treatment are analyzed. In the data analysis the researcher found that rehydration at two hours are related with the weight, randomization, vomiting, diarrhea, ondansetron and oral rehydration (Guarino, Ashkenazi, Gendrel, Vecchio, Shamir, & Szajewska, 2014). However, these factors do not affect the analyzed result. For the other analysis, the t test is done for the continuous variable. This is done to compare the analyzed data.   

The findings are very important because the literature includes the paucity of the high quality studies. This showed the rapid intravenous rehydration is very effective. From the findings, it is found that 45 children were administered the 50 mL/kg of the 0.09% saline in gap of 1 hour, whereas 43 children were administered the 50 mL/kg of the 0.09% saline in gap of 3 hours. However, from the rapid intravenous rehydration only 60% of the gastroenteritis can be cured. On the other hand, Maitland, Aceh, Russell, and Group (2011) mentioned that this is effective only for those who are suffering for the chronic dehydration. One of the study showed that both the rapid and standard intravenous rehydration process is effective for the moderate dehydration. Freedman, Parkin, Willan and Schuh (2011) stated that the rapid nasogastric rehydration is more effective for the pediatric patients with moderate dehydration. However, both the rapid and standard intravenous rehydration is safe for the children, who suffer from the gastroenteritis. In case of nastogastric rehydration, the dose of serum bicarbonate concentration is increased to 108 mmol/L. after the administration of nastogastric rehydration, the particular gravity dropped to the normal level rapidly than the rapid intravenous rehydration.

The authors assumed that the children who take the rapid intravenous rehydration could be discharged after three months. There is no changes are seen in between the children who are discharge after three hours of rapid intervention and standard intervention. The findings can be generalized by the smaller use of fluid boluses. The development of the hyperchloraemic acidosis is seemed counterintuitive. This is discussed previously in the children with gastroenteritis. When the plasma level rises excessively the condition of the acidosis became worsen (Sugata, Wakuda, Taniguchi, Asano, & Yoshikawa, 2014). Other potential explanation includes the existence of time lag in between the intravascular volume and clinical dehydration resolution. The rapid intravenous rehydration is effective at the time of early intervention.

Conclusion

Form the above discussion, it can be concluded that the research paper has various strengths and limitation. The children with gastroenteritis need the intravenous rehydration that can show the effective result in pediatric gastroenteritis. However, the researcher used the blinding and thus minimized the biasness. However, the researchers provided sufficient information in the research study to permit the replication of the study. This paper can help the future researchers and help in the health care system. The outcomes can be implemented in the health care system. Moreover, it is a peer reviewed journal that maintained the  ethical and professional ethics.

References

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