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Pesquisa
Multiple Electrolytes Solution Versus Saline as Bolus Fluid for Resuscitation in Pediatric Septic Shock: A Multicenter Randomized Clinical Trial*
Sankar, Jhuma MD1; Muralidharan, Jayashree MD2; Lalitha, A. V. MD3; Rameshkumar, Ramachandran MD, DM4; Pathak, Mona PhD5; Das, Rashmi Ranjan MD6; Nadkarni, Vinay M. MD7; Ismail, Javed MD8; Subramanian, Mahadevan MD4; Nallasamy, Karthi DM2; Dev, Nishanth MD9; Kumar, U. Vijay DM1; Kumar, Kiran MD1; Sharma, Taniya RN1; Jaravta, Kanika RN1; Thakur, Neha RN2; Aggarwal, Praveen MD10; Jat, Kana Ram MD1; Kabra, S. K. MD1; Lodha, Rakesh MD1. Multiple Electrolytes Solution Versus Saline as Bolus Fluid for Resuscitation in Pediatric Septic Shock: A Multicenter Randomized Clinical Trial*. Critical Care Medicine 51(11):p 1449-1460, November 2023. | DOI: 10.1097/CCM.0000000000005952
Abstract
OBJECTIVE:
To determine if initial fluid resuscitation with balanced crystalloid (e.g., multiple electrolytes solution [MES]) or 0.9% saline adversely affects kidney function in children with septic shock.
DESIGN:
Parallel-group, blinded multicenter trial.
SETTING:
PICUs of four tertiary care centers in India from 2017 to 2020.
PATIENTS:
Children up to 15 years of age with septic shock.
METHODS:
Children were randomized to receive fluid boluses of either MES (PlasmaLyte A) or 0.9% saline at the time of identification of shock. All children were managed as per standard protocols and monitored until discharge/death. The primary outcome was new and/or progressive acute kidney injury (AKI), at any time within the first 7 days of fluid resuscitation. Key secondary outcomes included hyperchloremia, any adverse event (AE), at 24, 48, and 72 hours, and all-cause ICU mortality.
INTERVENTIONS:
MES solution (n = 351) versus 0.9% saline (n = 357) for bolus fluid resuscitation during the first 7 days.
MEASUREMENTS AND MAIN RESULTS:
The median age was 5 years (interquartile range, 1.3–9); 302 (43%) were girls. The relative risk (RR) for meeting the criteria for new and/or progressive AKI was 0.62 (95% CI, 0.49–0.80; p < 0.001), favoring the MES (21%) versus the saline (33%) group. The proportions of children with hyperchloremia were lower in the MES versus the saline group at 24, 48, and 72 hours. There was no difference in the ICU mortality (33% in the MES vs 34% in the saline group). There was no difference with regard to infusion-related AEs such as fever, thrombophlebitis, or fluid overload between the groups.
CONCLUSIONS:
Among children presenting with septic shock, fluid resuscitation with MES (balanced crystalloid) as compared with 0.9% saline resulted in a significantly lower incidence of new and/or progressive AKI during the first 7 days of hospitalization.
Consulte artigo: DOI: 10.1097/CCM.0000000000005952
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