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

Summary

In 8,482 analyzed pediatric patients with suspected septic shock, balanced crystalloids did not reduce major adverse kidney events at 30 days compared with 0.9% saline. Electrolyte abnormalities differed, with less hyperchloremia and hypernatremia in the balanced-fluid group, but hospital-free days and safety profiles were similar.

Key Findings

• No significant difference in 30-day major adverse kidney events between balanced fluids (3.4%) and saline (3.0%).
• Hospital-free days were identical (median 23) in both groups.
• Hyperchloremia and hypernatremia were less frequent with balanced fluids than with saline.

Clinical Implications

Either balanced crystalloids or 0.9% saline are reasonable for initial resuscitation in pediatric septic shock with respect to major kidney outcomes; electrolyte profiles may guide choice (less hyperchloremia with balanced fluids).

Limitations

• Event rates for the composite kidney outcome were low (~3%), potentially limiting detection of small differences.
• Trial focused on the first 48 hours of resuscitation; longer-term fluid strategies were not assessed.

Future Directions

Evaluate subgroups (e.g., severe hyperchloremia risk, renal vulnerability) and integrate fluid composition with vasopressor and electrolyte management strategies in pediatric sepsis.