Retrospective Evaluation of Lactated Ringers vs. Normal Saline for Initial Resuscitation of Septic and Hypovolemic Shock in the Pediatric Intensive Care Unit

Background: Early and rapid fluid resuscitation is a key recommendation for the initial management of sepsis and septic shock. However, there continues to be debate regarding the best type of crystalloid solution to use. The 2020 Pediatric Surviving Sepsis International Guidelines provide a weak recommendation for the use of balanced crystalloid fluid rather than normal saline for the initial resuscitation of children with septic shock or other sepsis. Much of the data driving the recommendations in these guidelines stems from observational studies in pediatric patients and randomized controlled trials in adults. There is limited pediatric data showing mixed findings of benefit with important adverse effects that should be considered with both fluid options. This study aims to identify the safest and most efficacious fluid to use in the resuscitation of pediatric septic and hypovolemic shock. Methods: This is a retrospective, single-center database analysis that utilizes the Virtual Pediatric Systems database and the patient database from the OSF HealthCare Children's Hospital of Illinois. The patient population studied includes pediatric patients admitted to the pediatric intensive care unit (PICU) from 2016 to 2024 with septic shock or hypovolemic shock. A chart review was completed to extract data. The primary outcome of interest was the incidence of major adverse kidney events (MAKE) within 30 days, including in-hospital death, receipt of new renal replacement therapy, and persistent renal dysfunction at 30 days. Results: Results are to be determined at this time. This is an ongoing study, and we are currently in the data collection and analysis process. Data analysis will be complete at the time of ASN presentation. It is estimated that a sample size of approximately 200 patients will be presented. Conclusion: No conclusions can be made at this time as the data collection is occurring. We hypothesize that children with septic and hypovolemic shock admitted to the PICU will have better outcomes with lactated ringers compared to normal saline. The results of this study will supplement current literature and provide valuable results to help determine the safest and most effective fluid to use in patients presenting to the PICU with septic shock or hypovolemic shock.