Observational studyThe Journal of pediatrics2017
Crystalloid Fluid Choice and Clinical Outcomes in Pediatric Sepsis: A Matched Retrospective Cohort Study.
Observational study in The Journal of pediatrics, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03340805 (Pragmatic Pediatric Trial of Balanced Versus Normal Saline Fluid in Sepsis), which is not on this map. Cited by 23 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Pragmatic Pediatric Trial of Balanced Versus Normal Saline Fluid in Sepsis: A Pilot Feasibility Study
Who cites it
23 citing papers in PubMed, 3 syntheses or guidelines pooled it, 75 citations in OpenAlex.
- 2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 8. Pediatric advanced life support.Clinical and experimental emergency medicine · 2026Guideline
- Balanced crystalloid versus saline for resuscitation in pediatric septic shock: a systematic review and meta-analysis.BMC pediatrics · 2025Pooled it
- Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children.Intensive care medicine · 2020Guideline
- Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock.The New England journal of medicine · 2026Trial
- Balanced crystalloids versus 0.9% saline for fluid resuscitation in children with septic shock: an updated systematic review and meta-analysis of randomized controlled trials.Irish journal of medical science · 2026Review
- Balanced Crystalloids for Pediatric Sepsis and Septic Shock.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Review
- Balanced crystalloids versus isotonic saline in pediatric sepsis: a comprehensive systematic review and meta-analysis.Proceedings (Baylor University. Medical Center) · 2024Article
- Hyperchloremia on Admission to Pediatric Intensive Care in Mechanically Ventilated Children is Associated with Impaired Renal Function.Journal of pediatric intensive care · 2023Article
- Pediatric Sepsis: a Summary of Current Definitions and Management Recommendations.Current pediatrics reports · 2023Review
- Fluid bolus therapy in pediatric sepsis: a narrative review.European journal of medical research · 2022Review
- State-of-the-art management of the acutely unwell child.Anaesthesia · 2022Review
- Neonatal septic shock, a focus on first line interventions.Acta bio-medica : Atenei Parmensis · 2022Review
- Medication and Fluid Management of Pediatric Sepsis and Septic Shock.Paediatric drugs · 2022Review
- Hemodynamic monitoring and management of pediatric septic shock.Biomedical journal · 2022Review
- Article
- Article
- [Paediatric Life Support].Notfall & rettungsmedizin · 2021Review
- Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.Resuscitation · 2020Review
- How We Treat Fever and Hypotension in Pediatric Hematopoietic Cell Transplant Patients.Frontiers in oncology · 2020Review
- Pragmatic Pediatric Trial of Balanced Versus Normal Saline Fluid in Sepsis: The PRoMPT BOLUS Randomized Controlled Trial Pilot Feasibility Study.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2019Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo test the hypothesis that resuscitation with balanced fluids (lactated Ringer [LR]) is associated with improved outcomes compared with normal saline (NS) in pediatric sepsis. STUDY
designWe 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.
resultsThe 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.
conclusionsBalanced 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.