Research examines use of ultrasound to save critically ill children
When a child develops sepsis—an overwhelming, life-threatening response to infection—their body can struggle to maintain adequate blood flow and blood pressure. Without enough blood pressure, vital organs such as the brain, kidneys and heart can quickly become injured.
To restore and maintain adequate circulation and blood pressure, doctors give the child controlled amounts of intravenous fluid—a process called fluid resuscitation.
However, it is not a situation where “more is better.” Too much fluid can lead to dangerous complications such as lung swelling (pulmonary edema) or heart failure. In low- and middle-income countries like Kenya, where children often arrive in more severe states and where fewer resources exist to manage complications, determining the right about amount of fluids has been a “black box” according to Maria Srour, MD, MPH, assistant professor in division of pulmonary, critical care, sleep and occupational medicine at Indiana University School of Medicine.
“Every guideline we have for sepsis care mentions providing appropriate fluids, but there is a lot of controversy in low- and middle-income countries over how much fluid to give,” said Srour, who spent significant time doing research and clinical work in sepsis care in Kenya over the last several years. “We also have good data suggesting that using the same volumes recommended in high-income countries actually worsens outcomes for patients in low- and middle-income settings.”
Through the AMPATH Kenya partnership, Srour has joined forces with Joram Nyandat, MBChB, MMED (Paediatrics), FCCM, a paediatric intensivist at Moi Teaching and Referral Hospital (MTRH), Kenya, to use point-of-care ultrasound (POCUS) to guide fluid resuscitation in pediatric sepsis patients. They recently received a $50,000 global health reciprocal innovation grant from the Indiana Clinical and Translational Sciences Institute (CTSI) and IU Center for Global Health to train local Kenyan providers in POCUS assessment and to implement a new protocol tailored to each patient’s fluid needs.
“If we demonstrate that using POCUS can guide safer and more effective fluid resuscitation in sepsis, the implications extend far beyond our hospital,” said Nyandat. “In other parts of Africa and low- and middle-income countries, this could be adapted as a low-cost, high-impact intervention to reduce sepsis deaths. Even in high-income countries, improving precision in fluid management could lead to better outcomes, fewer complications, and shorter ICU stays. It is an opportunity to generate knowledge and tools that are globally relevant.”
“For me personally, as a paediatric intensivist in Kenya, I see everyday how limited resources and delayed interventions affect outcomes,” he continued. “I am passionate about improving the precision and safety of critical care interventions—especially for sepsis, which remains one of the leading causes of death in children in our setting.”
In the initial phase of the grant, which the team plans to launch in February 2026, they will educate providers at MTRH Shoe4Africa Children’s Hospital emergency department in basic POCUS techniques to assess fluid responsiveness and prevent fluid overload. This will include online learning as well as a two-week intensive in-person training.
“POCUS involves the use of a small, portable ultrasound device at the bedside,” explained Nyandat. “We can actually see how the heart is pumping, whether the blood vessels look full or empty, and whether fluid is backing up into the lungs or abdomen. This real time information allows us to adjust treatment dynamically.”
After training, the providers will apply their knowledge to implement a protocol that provides tailored, patient-specific care. The incidence of pulmonary edema, respiratory distress, vasopressor use, intensive care unit admission rates and death will then be compared to standard of care.
“If we can demonstrate that POCUS, which is relatively inexpensive and a learned, translatable skill, holds the answer to appropriate fluid resuscitation in sepsis, truly the sky is the limit,” said Srour. “This is potentially a protocol that could be replicated across various settings in Kenya, across Sub-Saharan Africa and other low-resource settings, and even in the U.S.”
Following the pilot, the team plans to replicate the study at Riley Hospital for Children in Indianapolis and other global settings. The reciprocal innovation demonstration grants are designed to fund research in shared priority areas for global partners and Indiana with innovations that can work in diverse settings around the globe. Investigators from the Indiana CTSI partner institutions (Indiana University, Purdue University, and the University of Notre Dame) are eligible to lead the grants with collaborators from both the U.S. and their partners in low- and middle-income countries.
Over the last eight years, the Indiana CTSI and IU Center for Global Health have awarded more than $660,000 through the Global Health Reciprocal Innovation grant program. Supported by the Indiana CTSI and funding by the National Center for Advancing Translational Sciences (grant number UM1TR004402), the planning and demonstration grants are awarded annually.
Srour is grateful for the grant funding and lauds the AMPATH Kenya partnership for making the collaboration possible. “The fact that Joram and I were able to connect, recruit a team of dedicated collaborators across IU, MTRH and Moi University (AMPATH lead institutions), and put together the grant application is a great testament to AMPATH and the infrastructure that it’s built up. The environment is incredibly supportive and built for investigators to ask important questions, design relevant studies, and attempt to answer those questions.”
For more information about the reciprocal innovation grants, please contact Laura Ruhl, MD, MPH, at ljruhl@iu.edu.
