33-Balanced Crystalloids Versus Saline for Initial Fluid Resuscitation in Children With Septic Shock
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Pediatrics, Sepsis, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Jhuma Sankar


Introduction/Hypothesis: Use of 'Balanced Crystalloids' as compared to 'Normal Saline' as initial fluid for resuscitation in children with septic shock may be associated with decreased risk of acute kidney injury (AKI) in the first 7 days.

Methods: Children <17 years' age with septic shock were randomized to receive boluses of either Balanced Crystalloids (Plasma-Lyte A; 'BC group') or Normal Saline ('NS group') for initial resuscitation at 4 study sites from 2017 to 2019. All children were managed as per the Surviving Sepsis Campaign Guidelines 2017 and were monitored till discharge/death. AKI was defined as per 2012 KDIGO clinical practice guidelines. Risk of AKI in the first 7 days after initial fluid resuscitation was the primary outcome. Other important outcomes were requirement of renal replacement therapy (RRT), risk of hyperchloremia and mortality.

Results: We enrolled 708 children: 351 and 357 in the 'BC' and 'NS' groups, respectively. Baseline characteristics were comparable. The fluid volumes received in the first 24 hours were similar in both groups (107 ml/kg in the 'BC' vs. 110 ml/kg in the 'NS' group; p= 0.93). There was a significant reduction in the risk of AKI (20% vs. 33%; RR: 0.62; 95% CI 0.48 to 0.80; p=0.0001) and requirement of RRT (10% vs. 20%; RR 0.50; 0.34 to 0.73; p=0.0002) in the 'BC group'. The risk of hyperchloremia at 72 hours was also lower in the 'BC group'. The mortality in both groups was however, similar (33% vs. 34%; RR 0.96; 0.78 to 1.19).

Conclusions: Use of Balanced Crystalloids for initial fluid resuscitation in children with septic shock was associated with significant reduction in the risk of new onset acute kidney injury. Balanced crystalloids should be preferred over Normal Saline for initial fluid resuscitation.


Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Sepsis
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Shock
Tag Fluids Resuscitation Management
Year 2021
Dr. Juma Shankar
multicenter clinical trial
balanced crystalloids
normal saline
acute kidney injury (AKI)


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