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PubMed2003

Basic principles and practical steps in the management of fluid balance in the newborn.

The fluid management of newborn babies can pose many problems. This article discusses the factors that affect fluid balance in the newborn infant, both term and preterm, and the special circumstances of the surgical neonate. The main determinants of management are: (1) an estimation of transepidermal water losses; (2) an awareness of glomerular filtration rate and how this is influenced by age, respiratory distress and medical intervention; and (3) knowledge of tubular function and its maturation and the processes of postnatal adaptation. This knowledge and appropriate monitoring are the mainstay of management of neonatal fluid balance.

Aging↗
PubMed2005

Management of fluid balance in CRRT: a technical approach.

BACKGROUND: The possibility of making fluid balance errors during continuous renal replacement therapy has been identified since the beginning of this modality of treatment. The advent of automated machines has partially overcome this problem. Nevertheless, there are conditions and operation modes in which the potential for fluid balance errors is still present. OBJECTIVE: To analyse fluid balance management in CRRT therapies across a range of currently marketed machine. METHODS: The tests were conducted in vitro, utilizing saline solution for the blood circuit and regular dialysate/reinfusate for the dialysate/reinfusion circuit. The methodology used was based on the voluntary creation of a fluid balance error by altering the correct flow in the circuit of the different machines. Subsequently, the time for alarm occurrence and the threshold value for fluid balance error was evaluated. The alarm was overridden and the overall fluid error allowed by the machine was evaluated. Each machine was tested in conditions of different dialysate/filtrate flow rates and in different simulated treatment modalities. RESULTS: Fluid balance errors can be easily avoided not only by a correct and careful adherence to the protocols of use of the current CRRT machines, but also by the compliance to prescriptions and programmed controls during therapy. Most importantly, if an alarm appears on the machine, one can try to override it without major problems; major problems may occur when multiple override commands are operated without identifying the problem and solving it adequately. CONCLUSION: Machines seem to be designed with adequate safety features and accurate alarm systems. However, features and alarms can be manipulated by operators creating the opportunity for serious error. Physicians and nurses involved in prescription and delivery of CRRT should have precise protocols and defined procedures in relation to machine alarms to prevent major clinical problems.

Acute Kidney Injury↗
PubMed2002

Techniques for assessing and achieving fluid balance in acute renal failure.

Fluid therapy, together with attention to oxygen supply, is the cornerstone of resuscitation in all critically ill patients. Hypovolemia results in inadequate blood flow to meet the metabolic requirements of the tissues and must be treated urgently to avoid the complication of progressive organ failure, including acute renal failure. The kidney plays a critical role in body fluid homeostasis. Renal dysfunction disturbs this homeostasis and requires special attention to issues of fluid balance and fluid overload. In addition, fluid therapy is the only treatment that has been shown to be effective in the prevention of acute renal failure. Special attention to volume status is therefore required in patients at risk for acute renal failure. Hypovolemia is also a major causal factor of morbidity during hemodialysis and may contribute to further renal insults. Although the importance of fluid management is generally recognized, the choice of fluid, the amount, and assessment of fluid status are controversial. As the choice of fluids becomes wider and monitoring devices become more sophisticated, the controversy increases. This article provides an overview of the concept of fluid management in the critically ill patient with acute renal failure.

Acute Kidney Injury↗
PubMed2003

Fluid balance measurements in disclosing fluid deposition during prolonged hypokinesia in healthy subjects.

Measuring fluid absorption and fluid homeostasis, the aim of this study was to establish if hypokinesia (HK) could depress fluid deposition and thus contribute to the development of fluid depletion. Studies were performed during 30 days pre-HK period and during 364 days HK period. Twenty healthy male individuals 24.0 +/- 6.6 years of age were chosen as subjects. They were equally divided into two groups: active control subjects (ACS) and hypokinetic subjects (HKS). All HKS were walking average distances of 0.7 +/- 0.2 km x day(-1) for 364 days, while all ACS were running average distances of 8.5 +/- 1.2 km x day(-1) for 364 days. Water imbalance, whole blood hemoglobin (Hb) and hematocrit (Hct), plasma protein, plasma osmolality, urinary and plasma sodium (Na+) and potassium (K+) levels and fluid loss increased significantly (p < 0.05), while fluid absorption, fluid consumption, glomerular filtration rate (GFR), and renal blood flow (RBF) reduced significantly (p < 0.05) in HKS compared with their pre-HK values and their respective active controls (ACS). Conversely, water balance, whole blood Hb and Hct, plasma protein, plasma osmolality, fluid absorption, GFR, RBF, urinary and plasma Na+ and K+ levels, fluid consumption and fluid loss did not change in ACS compared with their pre-HK control values. Significant increase of fluid loss with fluid imbalance may demonstrate decreased fluid deposition. Dissociation between fluid loss and fluid imbalance may demonstrate decreased fluid deposition as the mechanism of development of fluid depletion. It was concluded that fluid imbalance and the significant increase of Hb, Hct, plasma protein, plasma osmolality, urinary and plasma Na+ and K+ levels may demonstrate the presence of fluid depletion during prolonged HK in humans.

Adult↗
PubMed2006

Artificial hydration therapy, laboratory findings, and fluid balance in terminally ill patients with abdominal malignancies.

To explore the association between hydration volume and laboratory findings, and between calculated fluid balance and changes in clinical signs of dehydration and fluid retention in terminally ill cancer patients, a secondary analysis of a large multicenter, prospective, observational study was performed. The study enrolled 125 abdominal cancer patients who received laboratory examinations in the last week before death. Patients were classified into two groups: the hydration group (n = 44), who received 1L or more of artificial hydration per day both 1 and 3 weeks before death, and the nonhydration group (n = 81). The mean albumin level 1 week before death was significantly lower in the hydration group than in the nonhydration group, and the interaction between hydration group and decrease in the albumin level was statistically significant after adjusting multiple covariates (from 2.8 +/- 0.68 mg/dL 3 weeks before death to 2.4 +/- 0.56 mg/dL 24 hours before death in the hydration group vs. a decrease of 2.8 +/- 0.53 to 2.6+ /- 0.45 mg/dL in the nonhydration group, P = 0.015). There was no significant difference between the groups in the mean blood urea nitrogen/creatinine, sodium, or potassium levels 1 week before death. Among 53 patients who had oral fluid intake of less than 500 mL/day throughout the last 3 weeks and completed a fluid balance study, the median of calculated fluid balance was -400 mL/day 3 weeks before death, -521 mL/day 1 week before death, and -421 mL/day 24 hours before death. Calculated fluid balances did not significantly differ between the patients with deterioration of dehydration signs, edema, ascites, and pleural effusion during the final 3 weeks and those without. These data suggest that active artificial hydration might result in hypoalbuminemia, with no clear beneficial effects on normalizing blood urea nitrogen/creatinine, sodium, or potassium levels. Fluid balance did not significantly correlate with changes in dehydration-and fluid retention-signs. Calculated fluid balance is not an appropriate alternative to direct monitoring of patient symptoms. More studies are needed to determine the clinical efficacy of artificial hydration for terminally ill cancer patients.

Abdominal Neoplasms↗
PubMed1969

Transvascular fluid balance in the lung.

1. The transvascular fluid balance has been studied in isolated blood-perfused lungs of rabbit and cat. During periods of left atrial pressure (LAp) elevation, changes in preparation weight were measured. In some experiments simultaneous recordings of changes in blood volume, as judged by changes in emitted radioactivity from (51)Cr labelled red blood cells, were performed.2. In nine out of eleven experiments, elevation of LAp by 5 mm Hg within a test period of 8 min resulted in new weight stability and thus apparently in the establishment of a new transvascular fluid equilibrium. In five of these eleven experiments weight stability was also obtained on elevation of LAp by 10 mm Hg. When LAp was elevated further, transvascular fluid equilibrium was not obtained, and a continuous and eventually progressive outward flux of fluid occurred.3. In a preparation with the vasculature paralysed by papaverine in order to avoid vasomotor reactions, changes in plasma protein content caused immediate alterations in the weight slopes of the preparations. These alterations were interpreted as being due to changes in transvascular fluid transfer. Again new stable weights were obtained on moderate changes in plasma protein content.4. New weight and transvascular fluid equilibria seemed to be reached as a result of very small transvascular fluxes of fluid. The transvascular fluid balance in the lung may thus be dynamically maintained as a result of such small fluxes of fluid. The Starling hypothesis could account for this balance, provided that a small shift of fluid can cause sufficiently marked alterations in the osmotic and/or hydrostatic pressure gradient across the wall of the exchange vessels.5. The possible role of a small extravascular compartment with a high fluid colloid osmotic pressure is discussed in relation to transvascular fluid balance in the lung.

Animals↗
PubMed2002

Effect of flavor and awareness of kilojoule content of drinks on preference and fluid balance in team sports.

A palatable flavor is known to enhance fluid intake during exercise; however, a fear of excessive kilojoule intake may deter female athletes from consuming a sports drink during training sessions. In order to examine this issue, we monitored fluid balance during 9 separate training sessions undertaken by junior elite female netball players (n = 9), female basketball players (n = 7), and male basketball players (n = 8). The beverages tested were water, a regular carbohydrate-electrolyte beverage (6.8% CHO, 18.7 mmol/L Na, 3.0 mmol/L K, 1,130 kJ/L), and an identical tasting, low kilojoule electrolyte beverage (1% CHO, 18.7 mmol/L Na, 3.0 mmoI/L K, 170 kJ/L). Each subject received each of the 3 drinks at 3 separate training sessions, in a randomized, balanced order. Subjects were aware of the beverage provided. Change in body mass over the training session was used to estimate body fluid change, while voluntary fluid intake was determined from the change in weight of drink bottles used in each session. The overall fluid balance on drinks classified as regular, low kilojoule, and water was -11.3 ml/h (95%CI -99.6 to 77.0), -29.5 ml/h (95%CI -101.4 to 42.5) and-156.4 ml/h (95%CI-215.1 to-97.6), respectively. Theresults indicate that, overall, better fluid balance was achieved using either of the flavored drinks compared to water. These data confirm that flavored drinks enhance fluid balance in a field situation, and suggest that the energy content of the drink is relatively unimportant in determining voluntary fluid intake.

Adolescent↗
PubMed1983

Effects of sequential periods of intracranial hypertension on lung fluid balance.

Pulmonary hemodynamics and fluid and protein exchange were examined in dogs subjected to three successive periods of intracranial hypertension. Results indicate that the alteration in lung fluid balance is due to increased microvascular surface area following capillary recruitment. The relationship to the mechanism of neurogenic pulmonary edema is discussed.

Animals↗
PubMed2005

Intraoperative positive fluid balance improves tissue diffusion of ceftizoxime.

AIM OF STUDY: To demonstrate that administration of fluids and the consequent improvement of fluid balance during a surgical procedure can modify the tissue diffusion of ceftizoxime. METHODS: Twenty-eight patients (30-79 years) undergoing major abdominal surgery of the colon were administered ceftizoxime 30 mg/kg i.v. at induction of anesthesia. A sample of arterial blood was taken before administration of the drug (t0) and then again at the time of vascular occlusion of the colon segment to be removed (t1). A sample of the segment of removed colon was taken. The patients were divided into two groups on the basis of the fluid balance between t0 and t1: group A (n = 17) with a fluid balance <1,000 ml and group B (n = 11) with a fluid balance >1,000 ml. The parameters evaluated in each group were: weight, height and age of the patients, serum and tissue antibiotic concentration, percent ratio of serum and tissue concentration, time elapsed between t0 and t1, volume of administered fluids between t0 and t1, diuresis and hourly diuresis between t0 and t1 and body fluid distribution, obtained using a bioelectrical impedance analyzer. The mean results obtained in the two groups were then compared using Student's t test. RESULTS: The balance of fluids calculated up to t1 was 675 +/- 308 ml for group A and 1,411 +/- 405 ml for group B (p < 0.01). The means of the recorded values that showed statistically significant differences were: mean percent concentration ratio (43.6 +/- 8.4 vs. 84 +/- 16%; p < 0.05), concentration in the colonic segment (16.3 +/- 7.9 vs. 37.2 +/- 25.9 mg/ml; p < 0.05), urinary volume gathered up to t1 (538 +/- 557 vs. 169 +/- 104 ml; p < 0.05), hourly urinary volume up to t1 (311.1 +/- 296 vs. 97.6 +/- 77.9 ml/h; p < 0.05), percent variation of resistance (95.1 +/- 5.1 vs. 89.7 +/- 8.6; p < 0.05). The other means did not show any significant statistical differences. CONCLUSIONS: A higher tissue water level seems to facilitate the penetration of the antibiotic into the tissue according to the pharmacokinetic characteristics of ceftizoxime: high amount of free drug (not bound to plasma proteins) and high hydrosolubility.

Adult↗
PubMed2000

Negative fluid balance predicts survival in patients with septic shock: a retrospective pilot study.

OBJECTIVE: We hypothesized that patients with septic shock who achieve negative fluid balance (< or =-500 mL) on any day in the first 3 days of management are more likely to survive than those who do not. DESIGN: Retrospective chart review. PATIENTS: Thirty-six patients admitted with the diagnosis of septic shock. SETTING: Twelve-bed medical ICU of a 300-bed community teaching hospital. METHODS: Medical records of 36 patients admitted to our medical ICU over a 21-month period were examined. Patients with septic shock who required dialysis prior to hospitalization were not included. A number of demographic and physiologic variables were extracted from the medical records. Admission APACHE (acute physiology and chronic health evaluation) II and daily sequential organ failure assessment (SOFA) scores were computed from the extracted data. Variables were compared between survivors and nonsurvivors and in patients who did vs those who did not achieve negative (< or = 500 mL) fluid balance in > or = 1 day of the first 3 days of management. Survival risk ratios (RRs) were used as the measure of association between negative fluid balance and survival. RRs were adjusted for age, APACHE II scores, SOFA scores on the first and third days, and the need for mechanical ventilation, by stratified analyses. RESULTS: Patients ranged in age from 16 to 85 years with a mean (+/- SE) age of 67.4 +/- 3.3 years. The mean admission APACHE II score was 25.4 +/- 1.4, and the day 1 SOFA score was 9.0 +/- 0.8. Twenty patients did not survive; nonsurvivors had higher mean APACHE II scores than survivors (29.8 vs 20.4, respectively) and higher first day SOFA scores than survivors (10.8 vs 6.9, respectively), and they were more likely to require vasopressors and mechanical ventilation compared to patients who survived. Whereas all 11 patients who achieved a negative balance of > 500 mL on > or = 1 of the first 3 days of treatment survived, only 5 of 25 patient who failed to achieve a negative fluid balance of > 500 mL by the third day of treatment survived (RR, 5.0; 95% CI, 2.3 to 10.9; p = 0.00001). At least 1 day of net negative fluid balance in the first 3 days of treatment strongly predicted survival across the strata of age, APACHE II scores, first- and third-day SOFA scores, the need for mechanical ventilation, and creatinine levels measured at admission. CONCLUSION: These results suggest that at least 1 day of negative fluid balance (< or = -500 mL) achieved by the third day of treatment may be a good independent predictor of survival in patients with septic shock. These findings suggest the hypothesis "that negative fluid balance achieved in any of the first 3 days of septic shock portends a good prognosis," for a larger prospective cohort study.

APACHE↗
PubMedDate not supplied

Evaluating the reliability of recorded fluid balance to approximate body weight change in patients undergoing cardiac surgery.

OBJECTIVES: The objective of this study was to investigate body weight change in adult patients undergoing cardiac surgery and to assess the accuracy of conventional recorded fluid balance charting methods to reflect this change in body weight. DESIGN: This was a descriptive study. SETTING: This study was conducted at the cardiac care unit and medical-surgical intensive care unit (ICU) of a private hospital in Melbourne, Australia. SUBJECTS: The subjects were 32 adult patients who underwent cardiac surgical procedures. Twenty-six were male, and the mean age was 67 years (range 36-84 years). Twenty-three patients underwent coronary artery bypass graft surgery, and nine patients underwent heart valve repair or replacement+/-coronary artery bypass graft surgery between December 2003 and May 2004. OUTCOME MEASURES: The measures were recorded fluid balance for the perioperative period together with body weight measurements from the night before surgery and immediately on discharge from the ICU. An additional body weight measurement on the seventh postoperative day provided a trajectory of body weight gain or loss for the period of hospitalization after surgery. A retrospective medical history audit and an HV-CS digital chair scale (A&D Mercury Pty Ltd, Victoria, Australia) were used to collect the data. RESULTS: Analysis revealed that 30 patients increased their body weight from the night before surgery until discharge from the ICU. The mean weight gain was 3.34 kg (standard deviation [SD] 1.17, 95% confidence interval 2.70-3.98, P<.001). The average preoperative body weight was 80.97 kg (SD 16.79), whereas the average ICU postoperative weight was 83.94 kg (SD 16.15). Twenty-six patients (81.25%) had returned to, or were below, their preoperative weight by their seventh postoperative day (M 2.96 kg, SD 2.24 kg, P<.05). The average recorded fluid balance during the perioperative period was +1.56 L (SD 2.59 L, P<.001) with a difference of 1.39 kg between the recorded fluid balance and measured body weight change. Three patients (9.75%) met the criteria for accurate recorded fluid balance, and eight patients (25%) experienced a net difference in the opposite direction between recorded fluid balance and body weight change during the perioperative period. CONCLUSION: Body weight in patients who undergo cardiac surgery was found to fluctuate over the perioperative period. Use of recorded fluid balance to reflect change in body weight for patients undergoing cardiac surgery was deemed unreliable. Further investigation of body weight change and scrutiny of conventional recorded fluid balance charting methods for patients who undergo cardiac surgery is needed.

Adult↗
PubMed1997

Validation of multi-frequency bioelectrical impedance analysis in detecting changes in fluid balance of geriatric patients.

OBJECTIVES: Multi-Frequency Bioelectrical Impedance Analysis (MFBIA) is a quick, simple, and inexpensive method to assess body fluid compartments. This study aimed at determining the validity of MFBIA in detecting clinically relevant changes of fluid balance in geriatric patients. DESIGN: A prospective, observational study. SETTING: The 22-bed Geriatric Department of the University Hospital Nijmegen. PARTICIPANTS: Hospitalized patients were eligible if they did not have a pacemaker, were not suffering from terminal illnesses, and did not have psychogeriatric diseases likely to interfere with capacity to consent or comply. During a 16-months period, 218 patients were admitted, of whom 78 patients were eligible and 53 consented to participate. MEASUREMENTS: Each subject's fluid balance was diagnosed twice a week as dehydrated, overhydrated, or euvolemic, based on standardized physical examination, laboratory tests, and weight evaluation. Changes in fluid balance were quantified by measuring total body water (TBW) and extracellular fluid (ECF) applying deuterium- and bromide-dilution techniques. Impedance at 1, 5, 50, and 100 kHz and body weight were measured daily. Sensitivity and Guyatt's responsiveness indexes of MFBIA in detecting dehydration and overhydration were determined. RESULTS: In total, 1071 MFBIA measurements were performed, during which 14 transitions from dehydration to euvolemia and 13 transitions from overhydration to euvolemia were monitored. Rehydration of dehydrated patients caused an increase in TBW and ECF of 3.4 +/- 1.8 L and 1.9 +/- 1.9 L, respectively, which resulted in significant decreases in impedance of 133 +/- 67 omega at 1 kHz and 93 +/- 61 omega at 100 kHz (P = .001). Treatment of overhydrated patients caused a TBW and ECF loss of 3.8 +/- 4.2 L and 3.1 +/- 3.8 L, respectively, which resulted in significant increases in impedance of 104 +/- 72 omega at 1 kHz and 81 +/- 68 omega at 100 kHz (P < .001). Sensitivity of a single MFBIA in diagnosing dehydration and overhydration was 14% and 17%, respectively. Responsiveness indexes of weighing and MFBIA for dehydration and overhydration were similar at all frequencies and greater than one. CONCLUSION: The sensitivity of a single impedance measurement in detecting dehydration and overhydration was low. However, responsiveness of serial measurements to intra-individual changes in fluid balance was good. Therefore, this noninvasive technique may be used in clinical practice to improve monitoring fluid balance in geriatric patients, especially when daily weighing is difficult.

Activities of Daily Living↗
PubMed1995

A method of measuring fluid balance during transurethral resection of the prostate.

OBJECTIVE: To design a practical system for non-invasively monitoring fluid balance during transurethral resection of the prostate (TURP) and other endoscopic procedures. MATERIALS AND METHODS: Load cell transducers are incorporated into a platform placed under the operating table. Output is passed to a digital weighmeter and then to a portable computer. The raw data is filtered using software written by the authors (CAL) and the output displayed both numerically and graphically on the computer screen. The device was tested under laboratory conditions and then assessed in the clinical setting. RESULTS: The device proved stable in both the laboratory and clinical settings. Examples of the common patterns generated during TURP are presented. The prototype has been used routinely in our practice to warn the surgeon and anaesthetist of fluid overload and has been used to monitor fluid balance in several studies. CONCLUSIONS: This instrument provides a practical method of monitoring total fluid balance during TURP. It can be used with either general or regional anaesthesia and provides information not otherwise available. It provides an early warning of significant changes in total fluid balance, particularly irrigant fluid absorption. Use of this device serves to prevent development of the TUR syndrome, a potentially fatal complication of endoscopic surgery. Our ultimate aim is to produce a refined version that is simple, compact and cheap enough to be used routinely in all urological theatres. The cost of a single episode of intensive care for a patient developing iatrogenic complications from irrigant absorption would offset the cost of such a device.

Absorption↗
PubMed1996

Impact of pleurotomy, continuous positive airway pressure, and fluid balance during cardiopulmonary bypass on lung mechanics and oxygenation.

OBJECTIVE: To determine effects of surgical pleurotomy, continuous positive airway pressure, and fluid balance during cardiopulmonary bypass (CPB) on lung mechanical properties and indices of oxygenation. DESIGN: Prospective, descriptive, and interventional study. SETTING: Cardiothoracic service at a major university referral center. PARTICIPANTS: Eighteen anesthetized-paralyzed patients undergoing elective coronary artery bypass grafting requiring CPB. INTERVENTIONS: During CPB, continuous positive airway pressure (CPAP) was applied to nine patients, in nine others, no CPAP was applied. MEASUREMENTS AND MAIN RESULTS: From measurements of airway and esophageal pressures and flow, lung resistance and elastance were determined before sternotomy and after sternal reapproximation. Measurements were made during forced ventilation over a physiologic range of tidal volumes and frequencies, and frequency and volume dependences of lung resistance and elastance were additionally identified. In all patients, lung resistance and elastance increased after CPB, consistent with models of pulmonary edema. Multiple regression analysis showed that these increases were relatively less in patients with intact pleurae (p < 0.05) or net negative fluid balance (p < 0.05); however, no difference in these increases was noted between patients receiving CPAP and those receiving no CPAP. Increases in lung resistance were positively correlated to net fluid balance, and negatively correlated to frequency and tidal volume (p < 0.05). Increases in lung elastance were positively correlated to tidal volume (p < 0.05). Absolute change in alveolar-arterial oxygen gradient was negatively correlated with net fluid balance, whereas percentage change was positively correlated to changes in lung elastance (p < 0.05). CONCLUSIONS: These findings suggest that pleurotomy before CPB and positive fluid balance during CPB enhance postbypass pulmonary edema and/or atelectasis, as demonstrated by acute changes in respiratory mechanics and indices of oxygenation. Low levels of CPAP applied during CPB did not significantly change either mechanical properties or oxygenation.

Adult↗
PubMed2006

Weaning readiness and fluid balance in older critically ill surgical patients.

BACKGROUND: Few studies address predictors for successful weaning of older adults from mechanical ventilation. OBJECTIVE: To develop a clinical profile of older patients who are successfully weaned from long-term mechanical ventilation. METHODS: Forty patients in the trauma and surgical intensive care unit who were at least 60 years old were enrolled in the study after 3 days of active weaning and were monitored daily until successfully weaned or until the end of the 14-day study. Hemodynamic and gas exchange variables, fluid balance, oxygen cost of breathing, and scores on the Burns Weaning Assessment Program were analyzed. RESULTS: Compared with patients who were not weaned, successfully weaned patients required mechanical ventilation for 5.3 days, started active weaning earlier (mean 10.7 vs 14.5 days, P = .04), had lower mean negative daily fluid balances in the beginning (-0.394 vs 1.107 L, P = .004), and had lower mean net cumulative fluid balances (6.856 vs 16.212 L) at the time of enrollment. They also maintained both a lower mean net cumulative fluid balance (10.753 vs 25.049 L, P= .02) and a negative daily fluid balance (-0.389 vs 1.904 L, P = .03) throughout. Their mean central venous pressure decreased over time and was significantly lower (P<.001). CONCLUSION: Persistent positive fluid balance in older surgical patients is associated with prolonged mechanical ventilation. Estimates of fluid balance might be useful in weaning older patients from long-term mechanical ventilation.

Aged↗
PubMed2026

Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock.

BACKGROUND: Whether treatment with balanced crystalloid fluid leads to better outcomes than 0.9% saline in children treated for septic shock is debated. METHODS: In this pragmatic clinical trial conducted at 47 emergency departments in five countries, patients (2 months to <18 years of age) with suspected septic shock and abnormal perfusion were randomly assigned to receive fluid resuscitation with either balanced fluid or 0.9% saline for up to 48 hours. The primary outcome was a major adverse kidney event (a composite of death, new renal-replacement therapy, or persistent kidney dysfunction) at 30 days after enrollment or hospital discharge, whichever occurred first. RESULTS: Of 9041 enrolled patients, 277 (6.1%) in the balanced-fluid group and 282 (6.2%) in the 0.9%-saline group withdrew from the trial, leaving 4235 and 4247 patients, respectively, for analysis. A primary-outcome event occurred in 137 patients (3.4%) in the balanced-fluid group and in 124 (3.0%) in the 0.9%-saline group (difference, 0.4 percentage points; 95% confidence interval [CI], -0.5 to 1.3; risk ratio, 1.10; 95% CI, 0.88 to 1.40; P&#x2009;=&#x2009;0.85). The median number of hospital-free days during 28 days after enrollment was 23 (interquartile range, 19 to 25) in both groups. Hyperchloremia occurred in 868 patients (31.4%) in the balanced-fluid group and in 1383 (49.0%) in the 0.9%-saline group; hypernatremia in 52 (1.8%) and 89 (3.1%), respectively; and hyperlactatemia in 260 (19.8%) and 228 (16.7%). No differences in other safety outcomes or adverse events were seen. CONCLUSIONS: 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. (Funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development and others; PRoMPT BOLUS ClinicalTrials.gov number, NCT04102371.).

Adolescent↗