TOP 79 - Balanced fluids in children aged 0-6 years with acute respiratory illness admitted to the Pediatric Intensive Care Unit from 2015 to 2021

Publication Number: 1837.TOP 79

Jeff G. Lucien, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States; Ayesha Saeed. Malik, Maimonides Infants and Children's Hospital of Brooklyn, Brooklyn, NY, United States; Jeremy Silverstein, Maimonides Infants and Children's Hospital of Brooklyn, New York, NY, United States; Sindhu Kondaveeti, Children’s Hospital of Philadelphia, Philadelphia, PA, United States; George Foltin, Maimonides Infants and Children's Hospital of Brooklyn, Irvington, NY, United States

Background: Patients with acute respiratory failure (ARF) admitted to the Pediatric Intensive Care Unit (PICU) are prone to respiratory and metabolic acid-base disturbances, which may prolong the need for respiratory support. Such conditions often require intravenous fluid therapy. Critically ill infants and children with insensible losses and inadequate water replenishment who receive NaCl-containing fluids are at risk of developing hyperchloremic metabolic acidosis. Data on the ideal fluid choice for replenishment for these patients remain conflicting. This study examines the correction of hyperchloremic metabolic acidosis with a solution containing 0.45% NaCl with 77 mEq/L of sodium acetate, providing 154 mEq/L of sodium but only 77 mEq/L of chloride. The fluid is more balanced relative to plasma electrolyte composition and offers theoretical benefit through acetate metabolism to bicarbonate.

Objective: This ongoing project aims primarily to investigate whether balanced fluids with sodium acetate are equivalent or superior to fluids containing 0.9% NaCl in correcting electrolyte disturbances in critically ill children. Secondary outcomes include mechanical ventilation duration, length of stay in the PICU, time to normalization of laboratory values, and length of stay in the hospital.

Design/Methods: This retrospective cohort study analyzes 5 years of data from the PICU at Maimonides Children’s Hospital. Eligible patients are aged 0-6 years admitted with ARF. Exclusions include chronic conditions, metabolic disorders or asthma. Patients are categorized by predominant fluid type received. Manual chart review extracts demographics, clinical, and laboratory data. Categorical variables will be summarized as frequencies and percentages and compared across groups. This study assesses whether patients receiving balanced fluids are less likely to develop hyperchloremic metabolic acidosis and, as a result, have a shorter ICU length of stay. Findings may inform future pediatric fluid management protocols and guide larger prospective trials.