Examining our results graphically by syringe group, it appears as if there is a trend toward increased self-reported fatigue among providers using the 60 mL syringe size (Figure 6). This makes sense with what we know about the physics and physiology: it is physically more difficult for providers to depress the syringe plunger of fluid filled syringes of a larger diameter. While the presence of an interaction prevented us from assessing an impact on fluid administration time by bolus number, the interaction graph is itself interesting and somewhat instructive (Figure 5). The interaction appears to have occurred because the 10 mL group seemed

to “speed up” with time, while the other 3 syringe size groups appear to have slowed down with ongoing #Rucaparib cell line keyword# fluid resuscitation. One hypothesis that may be generated from this finding is that individuals in the 10 mL group may have become more efficient at connecting and disconnecting the Inhibitors,research,lifescience,medical syringes over the course of the intervention. Because the 10 mL group had the greatest number of syringes to connect and disconnect for each bolus, proportionally speaking, the time allocated to disconnecting and reconnecting syringes was greatest for this group. In contrast, the observation that the other

syringe size groups appeared to slow down with time would fit with our a priori hypothesis of provider fatigability. Our finding of progressive subjective Inhibitors,research,lifescience,medical fatigue among trial participants is certainly noteworthy and not previously reported in the Inhibitors,research,lifescience,medical literature. In other physically strenuous resuscitative tasks, such as the performance of chest compressions (CPR), current best practices involve frequent provider switches to avoid performance decay [15]. We suggest that given how fatiguing rapid manual fluid administration can be, perhaps routine provider switches are warranted for this resuscitation

task as well. This issue is not addressed in current resuscitation guidelines. A logical time for provider switches would be between 20 mL/kg boluses. The finding that a number of our study participants believed that regular infusion pumps were an adequate Inhibitors,research,lifescience,medical pediatric fluid resuscitation method underscores that more education is needed for HCPs regarding optimal fluid resuscitation performance. We still encounter standard IV pumps being inappropriately utilized in the setting of shock. Such pumps provide a maximum fluid delivery rate of 999 mL/hr, which in almost all cases is insufficient to achieve ACCM benchmarks. For example, for a 15 kg child, as simulated by much our model, a 20 mL/kg bolus would take 18 minutes to infuse with use of a regular IV pump. As such pumps are often the most convenient means to operationalize a fluid bolus order, it is imperative for the physicians writing such orders to be explicit regarding the intended time frame and method of administration. There are several limitations to our trial that warrant mention. Firstly, in a real resuscitation, syringes are not neatly prepared as was the case in our trial.