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Resuscitation With Balanced Fluids Is Associated With Improved Survival in Pediatric Severe Sepsis

Elizabeth T Emrath1, James D Fortenberry, Curtis Travers

  • 11Division of Pediatric Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.2Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, GA.3Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.

Critical Care Medicine
|April 25, 2017
PubMed

Insights

Using balanced fluids for pediatric severe sepsis resuscitation improved survival and reduced acute kidney injury. This study highlights the benefits of balanced fluids in critically ill children, showing better outcomes within 72 hours of treatment.

Area of Science:

  • Pediatric Critical Care Medicine
  • Fluid Resuscitation Strategies
  • Sepsis Management

Background:

  • Severe sepsis in children is a life-threatening condition requiring prompt fluid resuscitation.
  • The type of intravenous fluids used can significantly impact patient outcomes.
  • Understanding the effects of balanced versus unbalanced fluids is crucial for optimizing pediatric critical care.

Purpose of the Study:

  • To evaluate the impact of balanced fluid resuscitation on outcomes in pediatric patients with severe sepsis.
  • To compare mortality, acute kidney injury, and vasoactive infusion duration between balanced and unbalanced fluid groups.
  • To identify optimal fluid strategies for severe sepsis in pediatric intensive care units (PICUs).

Main Methods:

  • Retrospective observational cohort study using prospectively collected data from a large administrative database.
  • Analysis of data from 36,908 pediatric severe sepsis patients across 43 children's hospitals between 2004 and 2012.
  • Propensity matching was used to compare outcomes between patients receiving exclusively balanced fluids versus unbalanced fluids within the first 72 hours.

Main Results:

  • The 72-hour balanced fluids group showed significantly lower mortality (12.5% vs. 15.9%, p=0.007).
  • Balanced fluid resuscitation was associated with a decreased prevalence of acute kidney injury (16.0% vs. 19.2%, p=0.028).
  • Patients receiving balanced fluids had fewer vasoactive infusion days (3.0 vs. 3.3 days, p<0.001).

Conclusions:

  • Exclusive use of balanced fluids for the first 72 hours of resuscitation in pediatric severe sepsis is associated with improved survival.
  • Balanced fluid resuscitation significantly decreased the prevalence of acute kidney injury in this cohort.
  • The findings suggest that balanced fluids are a superior resuscitation strategy for pediatric severe sepsis, leading to shorter intensive care unit stays.
Abstract

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