Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock
Authors' conclusion
Among children treated for septic shock, no significant difference was seen in the incidence of death, new renal-replacement therapy, or persistent kidney dysfunction when fluid resuscitation was administered with balanced fluid as compared with 0.9% saline.
Study context
- Population
- Children (2 months to <18 years) with suspected septic shock and abnormal perfusion, 47 EDs in five countriesenrolled
- Participants
- 9,041 children
- Comparison
- Balanced fluid vs 0.9% saline for fluid resuscitation up to 48 hours
- Balanced fluidn = 4,235
- 0.9% salinen = 4,247reference
- Primary endpoint
- Major adverse kidney event:
- Death
- New RRT
- Persistent kidney dysfunction
- Follow-up
- 30 days after enrollment or hospital discharge, whichever occurred first
Methodological detailspragmatic, multicentre, 277 (6.1%) in the balanced-fluid group and 282 (6.2%) in the 0.9%-saline group withdrew
- Pragmatic
- Multicentre
- 277 (6.1%) in the balanced-fluid group and 282 (6.2%) in the 0.9%-saline group withdrew
Primary result
As reported in the abstract
Each group vs 0.9% salineDifference, percentage points (95% CI)
Balanced fluid
0.4(−0.5 to 1.3)
Each group vs 0.9% salineRelative risk (95% CI)P value
Balanced fluid
1.10(0.88–1.40)
P = 0.85Further findings
Hospital-free days · 28 days after enrollment
Safety
Hyperchloremia
Hypernatremia
Hyperlactatemia
Other safety outcomes and adverse events
- No differences seen
Original publication
Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock. N Engl J Med. Published 24 April 2026. doi:10.
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