Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock.

Summary

In 8482 analyzed children with suspected septic shock, balanced crystalloids did not reduce MAKE30 versus 0.9% saline (3.4% vs 3.0%; RR 1.10; P=0.85). Balanced fluids reduced hyperchloremia and hypernatremia without affecting hospital-free days or other safety outcomes.

Key Findings

• No difference in MAKE30 between balanced crystalloids and 0.9% saline (3.4% vs 3.0%; RR 1.10; 95% CI, 0.88–1.40; P=0.85).
• Hospital-free days were identical (median 23 days in both groups).
• Balanced fluids reduced hyperchloremia (31.4% vs 49.0%) and hypernatremia (1.8% vs 3.1%) but had higher hyperlactatemia (19.8% vs 16.7%).

Clinical Implications

Either balanced crystalloids or 0.9% saline are reasonable for resuscitation in pediatric septic shock; balanced fluids lower hyperchloremia risk. Fluid selection can be individualized based on electrolyte profiles and availability while focusing on timely antibiotics and vasoactive support.

Limitations

• Open-label pragmatic design with potential for co-intervention variability
• Enrollment based on suspected septic shock may include diagnostic heterogeneity

Future Directions

Assess subgroup effects (e.g., severe hyperchloremia risk, traumatic brain injury) and long-term kidney outcomes; evaluate fluid strategies integrated with vasopressor timing and electrolyte-guided protocols.