560 - A Retrospective Evaluation of Lactated Ringers Versus Normal Saline for Initial Resuscitation of Septic and Hypovolemic Shock in the Pediatric Intensive Care Unit

Publication Number: 4548.560

Alexander Tran, University of Illinois College of Medicine Peoria, Peoria, IL, United States; Grace Ryan, University of Illinois College of Medicine Peoria, Peoria, IL, United States; Collins Odhiambo, UI Health, Peoria, IL, United States; Jonathan A. Gehlbach, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Deepa Chand, Children's Hospital of the University of Illinois, Oak Park, IL, United States

Background: Early and rapid fluid resuscitation is a key recommendation for the initial management of sepsis and septic shock. The 2020 Pediatric Surviving Sepsis international guidelines provide a “weak recommendation” for the use of balanced crystalloid fluid rather than normal saline (NS) for the initial resuscitation of children with septic shock or other sepsis. These recommendations are based on observational studies in pediatric patients and are supported by conclusions from randomized controlled trials in adult patients. Given the mixed data in the current literature, further research is needed to identify the safest and most efficacious fluid for resuscitation in pediatric septic and hypovolemic shock.

Objective: This study aims to identify the safest and most efficacious fluid to use in the resuscitation of pediatric septic and hypovolemic shock.

Design/Methods: This retrospective, single-center study used the Virtual Pediatric Systems (VPS) database and electronic medical records from the OSF HealthCare Children's Hospital of Illinois. The population includes patients admitted to the pediatric intensive care unit from 2016 to 2024 with septic shock or hypovolemic shock. The primary outcome of interest was major adverse kidney events within 30 days of presentation (MAKE30), including death, renal replacement therapy (RRT), or persistent renal dysfunction at 30 days.

Results: A total of 426 pediatric patients were identified through VPS, of whom 67 pediatric patients were included. Approximately 30% of patients received more than one type of fluid within 24 hours of initial presentation. Fluid resuscitation evaluation showed that patients received higher amounts of NS boluses (mean 42.7 mL/kg) compared to lactated ringers (LR) boluses (mean 6.4 mL/kg). MAKE30 events occurred in 13.4% of patients, more frequently in those receiving LR (16.7%) compared to those receiving NS (12.7%) (p = 0.658). Persistent renal dysfunction at 30 days was higher in the LR group (16.7% vs. 9.1%; p = 0.600). In-hospital mortality within 30 days occurred exclusively in patients receiving NS (7.5%), although this difference did not reach statistical significance (p = 0.167). No patients required RRT.

Conclusion(s): There were no statistically significant differences in MAKE30 between patients receiving LR and those given NS for initial fluid resuscitation. Although these interim results suggest both fluid types are equally safe for the initial resuscitation of patients presenting with septic and hypovolemic shock, there was a preference for NS as the choice of fluid at this institution.

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Curriculum Vitae.pdf