Vijendra Barkhá, Bertol Ana Beatriz, de Almeida Mylena Maria Guedes, de Freitas Pedro Henrique Aquino Gil, Simão Áurea Maria Salomão, de Faria Bianca Lisa
Faculdade de Medicina, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique.
Universidade do Sul de Santa Catarina, Florianópolis, SC, Brazil.
BMC Pediatr. 2025 Jan 31;25(1):81. doi: 10.1186/s12887-025-05442-w.
Fluid resuscitation is a cornerstone of septic shock management in pediatric patients, with normal saline (NS) being the traditional choice. However, balanced solutions (BS) have gained attention due to their potential to mitigate acid-base and electrolyte disturbances. Despite this, the optimal choice between BS and NS for pediatric sepsis remains unclear. Therefore, we aimed to conduct a meta-analysis comparing the clinical outcomes of BS versus NS in pediatric patients with sepsis.
We systematically searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials, along with reference lists of retrieved publications, for studies comparing clinical outcomes in pediatric patients with sepsis treated with BS versus NS. Our outcomes of interest included acute kidney injury (AKI), hospital mortality, hospital length of stay, pediatric intensive care unit (PICU) length of stay, need for renal replacement therapy, hyperchloremia and mechanical ventilation. We performed statistical analysis using Review Manager Web 8.0.0 and Rstudio.
We included 12,231 patients from 8 studies, of which 4 were randomized clinical trials (RCTs). BS was used to treat septic shock in 2,460 (20.1%) patients. The mean age was 5.98 ± 3.08 years, with 43.82% female patients. Follow-up ranged from 3 to 90 days. We found no statistically significant difference between groups in AKI, hospital mortality, mechanical ventilation, need for renal replacement therapy, and PICU length of stay. Hospital length of stay in days was significantly longer with BS compared to NS (MD 3.38; 95% CI 1.13 to 5.64; p = 0.003; I² = 0%) and the occurrence of hyperchloremia was lower in the BS compared to NS (RR 0.70; 95% CI 0.59 to 0.82; p = 0.0001; I² = 0%). In a subgroup analysis of RCTs only, AKI occurrence was not significantly different between BS and NS groups (RR 0.81; 95% CI 0.48 to 1.38; p = 0.44; I² = 18%). However, the need for renal replacement therapy was significantly less frequent in patients treated with BS compared to NS (RR 0.58; 95% CI 0.39 to 0.87; p = 0.008; I² = 0%).
In pediatric septic shock patients, treatment with balanced solutions (BS) was associated with a lower need for renal replacement therapy and a reduced occurrence of hyperchloremia. However, hospital length of stay was longer in patients treated with BS compared to those receiving normal saline (NS). These results underscore the complexity of fluid management in pediatric septic shock and emphasize the need for further research.
液体复苏是小儿脓毒性休克治疗的基石，生理盐水（NS）是传统选择。然而，平衡溶液（BS）因其减轻酸碱和电解质紊乱的潜力而受到关注。尽管如此，对于小儿脓毒症，BS和NS之间的最佳选择仍不明确。因此，我们旨在进行一项荟萃分析，比较BS与NS治疗小儿脓毒症患者的临床结局。
我们系统检索了PubMed、EMBASE和Cochrane对照试验中央注册库以及检索到的出版物的参考文献列表，以寻找比较用BS与NS治疗的小儿脓毒症患者临床结局的研究。我们感兴趣的结局包括急性肾损伤（AKI）、医院死亡率、住院时间、儿科重症监护病房（PICU）住院时间、肾脏替代治疗需求、高氯血症和机械通气。我们使用Review Manager Web 8.0.0和Rstudio进行统计分析。
我们纳入了来自8项研究的12231例患者，其中4项为随机临床试验（RCT）。2460例（20.1%）患者使用BS治疗脓毒性休克。平均年龄为5.98±3.08岁，女性患者占43.82%。随访时间为3至90天。我们发现两组在AKI、医院死亡率、机械通气、肾脏替代治疗需求和PICU住院时间方面无统计学显著差异。与NS相比，BS治疗的患者住院天数显著更长（MD 3.38；95%CI 1.13至5.64；p = 0.003；I² = 0%），且与NS相比，BS组高氯血症的发生率更低（RR 0.70；95%CI 0.59至0.82；p = 0.0001；I² = 0%）。仅在RCT的亚组分析中，BS组和NS组的AKI发生率无显著差异（RR 0.81；95%CI 0.48至1.
