Data on 9,000 children with septic shock shows no difference in kidney outcomes between two common types of IV fluids used for emergency resuscitation.
RT’s Three Key Takeaways:
- Fluid Comparison: A randomized clinical trial involving more than 9,000 patients found that balanced crystalloid fluid and 0.9% saline are equally safe and effective for treating pediatric septic shock.
- Kidney Safety: The study reported no difference in outcomes such as major adverse kidney events or persistent kidney dysfunction at 30 days regardless of which intravenous (IV) fluid was used for resuscitation.
- Resource Availability: These findings suggest that healthcare centers can confidently utilize whichever IV fluid is most accessible without impacting the quality of care for children with suspected septic shock.
A randomized clinical trial conducted across five countries established that both commonly used intravenous (IV) fluids for treating septic shock—balanced crystalloid fluid and 0.9% saline—are equally safe and effective for children, according to a study published in the New England Journal of Medicine.
The trial included 47 pediatric emergency departments, including Ann & Robert H Lurie Children’s Hospital of Chicago. Septic shock is a life-threatening medical emergency where the body’s extreme response to infection causes organ failure. Healthcare providers use IV fluids for resuscitation to stabilize patients and support organ function.
“Our study provides a definitive answer that there is no additional benefit or harm from using one type of IV fluid over another for septic shock resuscitation in children,” said Elizabeth Alpern, MD, MSCE, division head of emergency medicine at Lurie Children’s and professor of pediatrics at Northwestern University Feinberg School of Medicine.
The study enrolled more than 9,000 children aged 2 months to less than 18 years with suspected septic shock. Researchers found no difference in outcomes such as major adverse kidney events or persistent kidney dysfunction at 30 days. Previous smaller studies had shown mixed results regarding whether balanced fluids, which mimic blood composition, provided more benefits for the kidneys than saline.
“We found no difference in outcomes, such as major adverse kidney event or persistent kidney dysfunction at 30 days. This is great news, since centers around the world can now confidently use whichever of these IV fluids is readily available,” said Alpern, study co-author, in a news release.
Because obtaining standard informed consent is not always feasible in emergency situations, researchers engaged the community for input during the study development. This included focus groups with parents of children at high risk for sepsis, including those with cancer, immune deficiencies, and other complex conditions.
“It was very important to us to make sure that parents and patients understood what we were trying to accomplish, and that we heard and addressed any possible concerns prior to launching this study,” said Alpern. “Now we can move on from the debate about what kind of fluid is best and focus on new ways to improve care for kids with septic shock.”
