• Jhuma Sankar, Jayashree Muralidharan, A V Lalitha, Ramachandran Rameshkumar, Mona Pathak, Rashmi Ranjan Das, Vinay M Nadkarni, Javed Ismail, Mahadevan Subramanian, Karthi Nallasamy, Nishanth Dev, U Vijay Kumar, Kiran Kumar, Taniya Sharma, Kanika Jaravta, Neha Thakur, Praveen Aggarwal, Kana Ram Jat, S K Kabra, and Rakesh Lodha.
• Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
• Crit. Care Med. 2023 Nov 1; 51 (11): 144914601449-1460.

ObjectiveTo 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.DesignParallel-group, blinded multicenter trial.SettingPICUs of four tertiary care centers in India from 2017 to 2020.PatientsChildren up to 15 years of age with septic shock.MethodsChildren 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.InterventionsMES solution ( n = 351) versus 0.9% saline ( n = 357) for bolus fluid resuscitation during the first 7 days.Measurements And Main ResultsThe 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.ConclusionsAmong 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.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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