• Elizabeth T Emrath, James D Fortenberry, Curtis Travers, Courtney E McCracken, and Kiran B Hebbar.
• 1Division 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.
• Crit. Care Med. 2017 Jul 1; 45 (7): 1177-1183.

ObjectiveTo evaluate outcomes in patients receiving balanced fluids for resuscitation in pediatric severe sepsis.DesignObservational cohort review of prospectively collected data from a large administrative database.SettingPICUs from 43 children's hospitals.PatientsPICU patients diagnosed with severe sepsis.InterventionsNone.Measurements And Main ResultsWe reviewed data from the Pediatric Health Information System database from 2004 to 2012. Children with pediatric severe sepsis receiving balanced fluids for resuscitation in the first 24 and 72 hours of treatment were compared to those receiving unbalanced fluids. Thirty-six thousand nine hundred eight patients met entry criteria for analysis. Two thousand three hundred ninety-eight patients received exclusively balanced fluids at 24 hours and 1,641 at 72 hours. After propensity matching, the 72-hour balanced fluids group had lower mortality (12.5% vs 15.9%; p = 0.007; odds ratio, 0.76; 95% CI, 0.62-0.93), lower prevalence of acute kidney injury (16.0% vs 19.2%; p = 0.028; odds ratio, 0.82; 95% CI, 0.68-0.98), and fewer vasoactive infusion days (3.0 vs 3.3 d; p < 0.001) when compared with the unbalanced fluids group.ConclusionsIn this retrospective analysis carried out by propensity matching, exclusive use of balanced fluids in pediatric severe sepsis patients for the first 72 hours of resuscitation was associated with improved survival, decreased prevalence of acute kidney injury, and shorter duration of vasoactive infusions when compared with exclusive use of unbalanced fluids.

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