Balanced Salt Solution Versus Normal Saline in Resuscitation of Pediatric Sepsis: A Randomized, Controlled Trial

Area of Science:

• Pediatric critical care medicine
• Resuscitation science
• Fluid therapy

Background:

• Current evidence on crystalloid fluid resuscitation in adult sepsis is extensive, yet data specific to pediatric populations remains limited.
• Understanding the impact of different crystalloid solutions on pediatric sepsis resuscitation outcomes is crucial for clinical practice.

Purpose of the Study:

• To compare the resuscitation outcomes of pediatric sepsis patients treated with normal saline solution (NSS), Ringer lactate solution (RLS), or Sterofundin.
• To investigate the association between crystalloid type and complications in pediatric sepsis resuscitation.

Main Methods:

• A randomized trial involving 42 pediatric sepsis patients requiring fluid bolus therapy.
• Patients were assigned to receive either NSS, RLS, or Sterofundin.
• Outcomes, including complications and urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels, were assessed post-fluid bolus.

Main Results:

• No significant differences in complications were observed among the three crystalloid groups after fluid bolus.
• Patients in the RLS group who received a large fluid dose demonstrated a significant reduction in uNGAL levels.
• This suggests a potential benefit of RLS in reducing a specific biomarker of kidney injury in pediatric sepsis.

Conclusions:

• Fluid bolus therapy with NSS, RLS, or Sterofundin did not lead to different overall resuscitation outcomes in pediatric sepsis.
• Higher doses of RLS may be associated with a greater reduction in uNGAL levels compared to other crystalloids, indicating a potential role in mitigating kidney stress.