Title: Crystalloid fluid choice in Pediatric Sepsis<br/>Author: Mimi Lu<br/><a href='http://umem.org/profiles/faculty/185/'>[Click to email author]</a><hr/><ul>
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                <span><span>Resuscitation with <span>crystalloid fluid <span>is a cornerstone of pediatric septic shock treatment</span></span></span></span><span>.</span></li>
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                <span><span>Recent publication from the adult literature have suggested that balance crystalloid solutions may be better than</span><span> 0.9%</span><span> normal saline (NS) for <span>select conditions.</span></span></span></li>
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                <span><span><span><span>Lactated Ringer's (LR) is a common balance crystalloid solution often used for fluid resuscitation</span><span> and critically ill patient</span>s.</span></span></span></li>
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                <span><span><span><span>However <span>whether </span>resuscitation with balance fluids <span>is associated with improved outcomes compared to NS</span><span> in pediatric sepsis</span><span> is unclear.</span></span></span></span></span></li>
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                <span><span><span><span><span><span>A matched retrospective cohort study</span><span> of 12,529 <span>pediatric </span>patient <span>with severe sepsis/septic shock</span><span> at 382 US hospitals</span><span> compared outcomes</span><span> with versus without LR as a part of the initial resuscitation</span>.</span></span></span></span></span></span></li>
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                <span><span><span><span><span><span><span>Outcomes includesd: 30-day hospital mortality, acute kidney injury, new dialysis, and length of stay</span><span>.</span></span></span></span></span></span></span></li>
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                <span><span><span><span><span><span><span><span>After matching, mortality was not different between LR and NS groups.</span><span> There were no differences in secondary outcomes except longer hospital length of stay in<span> the LR groups</span></span></span></span></span></span></span></span></span>.</li>
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                <span>The PRoMPT BOLUS randomized control</span><span> trial pilot was a</span><span> feasibility study <span>designed to study the comparative effectiveness of LR versus NS fluid resuscitation for pediatic septic shock.  Completion of a more robust study may help provide answers to these ongoing questions. </span></span></li>
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        <u><strong>Bottom line</strong></u>: <span>Balance fluid resuscitation with LR was not associated with improved outcomes compared to NS and pediatric sepsis.</span><span> Selective <span>LR use necessitates a prospective trial to definitively determine comparative effects among crystalloids.</span></span></p>
<fieldset><legend>References</legend>

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        1. Weiss SL, Keele L, Balanmuth F, Vendetti N, Ross R, Fitzgerald JC, Gerber JS. <span> Crystalloid Fluid Choice and Clinical Outcomes in Pediatric Sepsis: A Matched Retrospective Cohort Study.</span> J Pdatr.207 Mar:182:304-310.</p>
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        2. Balamuth F, Kittick M, McBride P, Woodford AL, Vestal N, Casper TC, Metheney M, Smith K, Atkin NJ, Baren JM, Dean JM, Kuppermann N, Weiss SL.  Pragmatic Pediatric Trial of Balanced versus Normal Saline Fluid in Sepsis: The PRoMPT BOLUS Randomized Controlled Trial Pilot Feasibility Study. Acad Emerg Med. 2019 Jun 10</p>
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