title: Crystalloid Fluid Choice and Clinical Outcomes in Pediatric Sepsis: A Matched Retrospective Cohort Study.
abstract: To test the hypothesis that resuscitation with balanced fluids (lactated Ringer [LR]) is associated with improved outcomes compared with normal saline (NS) in pediatric sepsis.
  
  
  
  We performed matched analyses using data from 12 529 patients <18 years of age with severe sepsis/septic shock at 382 US hospitals between 2000 and 2013 to compare outcomes with vs without LR as part of initial resuscitation. Patients receiving LR were matched 1:1 to patients receiving only NS (NS group), including separate matches for any (LR-any group) or exclusive (LR-only group) LR use. Outcomes included 30-day hospital mortality, acute kidney injury, new dialysis, and length of stay.
  
  
  
  The LR-any group was older, received larger crystalloid volumes, and was less likely to have malignancies than the NS group. After matching, mortality was not different between LR-any (7.2%) and NS (7.9%) groups (risk ratio 0.99, 95% CI 0.98, 1.01; P = .20). There were no differences in secondary outcomes except longer hospital length of stay in LR-any group (absolute difference 2.4, 95% CI 1.4, 5.0 days; P < .001). Although LR was preferentially used as adjunctive fluid with large-volume resuscitation or first-line fluid in patients with lower illness severity, outcomes were not different after matching stratified by volume and proportionate LR utilization, including for patients in the LR-only group.
  
  
  
  Balanced fluid resuscitation with LR was not associated with improved outcomes compared with NS in pediatric sepsis. Although the current practice of NS resuscitation is justified, selective LR use necessitates a prospective trial to definitively determine comparative effectiveness among crystalloids.
authors.affiliation: Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Electronic address: WeissS@email.chop.edu.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Weiss
authors.affiliation: McCourt School of Public Policy and Department of Government, Georgetown University, Washington, DC.
authors.forename: Luke
authors.initials: L
authors.lastname: Keele
authors.affiliation: Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA; Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Fran
authors.initials: F
authors.lastname: Balamuth
authors.affiliation: Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Neika
authors.initials: N
authors.lastname: Vendetti
authors.affiliation: Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Rachael
authors.initials: R
authors.lastname: Ross
authors.affiliation: Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Fitzgerald
authors.affiliation: Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA; Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
mesh_terms: D000293:Adolescent; D000367:Age Factors; D016022:Case-Control Studies; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D000077324:Crystalloid Solutions; D016208:Databases, Factual; D005260:Female; D005440:Fluid Therapy / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007552:Isotonic Solutions / Q000008:administration & dosage*; D008297:Male; D011379:Prognosis; D012151:Resuscitation / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D000077325:Ringer's Lactate; D018570:Risk Assessment; D018805:Sepsis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D012737:Sex Factors; D012772:Shock, Septic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D012965:Sodium Chloride / Q000008:administration & dosage; D016019:Survival Analysis
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012965:Sodium Chloride
keywords: balanced fluids; critically ill children; crystalloids; isotonic saline; mortality; sepsis