A comparison of NSS vs balanced salt solution as a fluid resuscitation and impact of fluid balance on clinical outcomes in pediatric septic shock
Septic shock is a common condition affecting children worldwide. Initial resuscitation with crystalloid fluid is the first step in treatment of septic shock. However, there is increasing concern about side effects of using normal saline. Our objective was to compare the effectiveness of balanced salt solution vs 0.9% normal saline solution (NSS) on decreasing morbidity and mortality in pediatric septic shock. This was a prospective observational study enrolled septic children aged 1-15 years treated at the Department of Pediatrics, King Chulalongkorn Memorial Hospital. They were given fluids resuscitation according to Surviving Sepsis Campaign (SSC) guidelines. Thirty-five sepsis children were enrolled, 20 received normal saline as first line fluid resuscitation and 15 received balanced salt solution (Ringer lactate solution [RLS]) as first line fluid resuscitation. Baseline characteristic of both groups were similar. RLS group received significantly less fluid resuscitation at 24 and 48 hours compared to NSS group (134.3±42.9 vs 171.3±49.5; p=0.02, 236.9±75.7 vs 313.1±115.3; p=0.03). Moreover, RLS group had significantly less metabolic acidosis and better base excess at 6 hours and 24 hours compared to NSS group (2.5±4.1 vs -3.7±4.1; p<0.001, 3.4±3.2 vs -1.2±3.9; p=0.03). There was no statistically significant difference in mortality between two groups (15% [n=3] NSS, 6.7% [n=1] RLS).
Conclusion: Using balanced salt solution for resuscitation decreased metabolic acidosis and tended to decrease fluid intake and fluid accumulation.