A large-scale clinical trial involving 9,041 children across five countries has found no significant difference in major adverse kidney events between balanced crystalloid fluids and 0.9% saline for treating septic shock.
Clinical Trial Results on Septic Shock Resuscitation
The study, led by F. Balamuth and colleagues, sought to resolve long-standing debates regarding optimal fluid resuscitation in pediatric emergency care. Researchers randomly assigned children aged 2 months to 18 years, who presented with suspected septic shock and abnormal perfusion, to receive either balanced fluid or 0.9% saline for up to 48 hours.
Data from 8,482 participants—4,235 in the balanced fluid group and 4,247 in the saline group—showed that a primary adverse kidney event occurred in 3.4% of those receiving balanced fluid compared to 3.0% of those receiving saline. This 0.4 percentage point difference was not statistically significant, with a risk ratio of 1.10 (95% confidence interval, 0.88 to 1.40). Hospital-free days were also identical between the groups, averaging 23 days in the 28-day study period.
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While clinical outcomes like survival and kidney function remained similar, the choice of fluid significantly altered laboratory markers. Hyperchloremia was observed in 49.0% of the saline group, compared to 31.4% in the balanced fluid group.
Electrolyte Variations and Clinical Implications
While the study found that neither fluid strategy was superior in preventing major adverse kidney events, the physiological impact on electrolytes differed. The use of 0.9% saline was associated with a higher incidence of hyperchloremia and hypernatremia. Conversely, children treated with balanced fluid showed a higher incidence of hyperlactatemia, occurring in 19.8% of cases compared to 16.7% in the saline group.
These findings suggest that while clinicians may observe shifts in specific electrolyte measures based on the fluid chosen, these laboratory changes do not necessarily translate into different long-term survival or kidney health outcomes for pediatric patients. The study provides a significant evidence base for emergency departments tasked with selecting resuscitation protocols for septic shock.
Future Trends in Pediatric Fluid Management
Frequently Asked Questions
Does balanced fluid reduce the risk of kidney failure in children with septic shock?
No. The trial found that balanced fluid did not significantly reduce the incidence of major adverse kidney events compared to 0.9% saline.
Are there differences in electrolyte levels when using these fluids?
Yes. Saline is associated with higher rates of hyperchloremia and hypernatremia, while balanced fluids are associated with higher rates of hyperlactatemia.
How many children were included in this study?
The trial included 9,041 children across 47 emergency departments, with 8,482 included in the final analysis.
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