Hypertonic versus normal saline as initial fluid bolus in pediatric septic shock.

ABSTRACT

OBJECTIVE: To compare the efficacy of 3% saline and 0.9% saline infusion as initial resuscitative fluid therapy in children with septic shock. METHODS: Sixty children between 2 to 12 years of age with septic shock were randomized to receive normal saline or 3% saline as initial resuscitative fluid. Fluid resuscitation was done with 0.9% saline in boluses of 20 ml/kg, each bolus over a duration of 15 min with a maximum of 2 boluses. Fluid resuscitation with 3% saline was given as a single bolus of 15 ml/kg over 30 min. After initial fluid bolus completion, if hemodynamic stability was not achieved then further fluid boluses of 0.9% saline were given in volumes of 5-10 ml/kg guided by CVP. RESULTS: There were 30 patients in both the groups. Both the groups were identical with respect to age, gender, primary diagnosis, laboratory parameters, initial hemodynamic parameters and PRISM score at time of admission. The amount of total fluid bolus required for resuscitation was approximately half in the group who received 3% saline as compared to the group who received 0.9% saline. The use of vasopressor drugs, shock reversal time, ICU stay and mortality rate were similar in both the groups. No adverse effects related to fluid therapy were observed in any of the groups. CONCLUSIONS: Both normal saline and hypertonic saline were equally effective as resuscitation fluid with respect to restoration of hemodynamic stability, average duration of ICU stay and mortality. Hypertonic saline appears to be a promising fluid for resuscitation of septic shock.