Balanced Solutions Versus Normal Saline in Pediatric Septic Shock: A GRADE-Assessed Systematic Review and Meta-Analysis of Randomized Controlled Trials
In brief
Balanced fluids lowered dialysis use by 32% in children with septic shock
Across six randomized trials involving 9,743 children, balanced fluids did not reduce short-term mortality compared with normal saline: deaths occurred in 3.5% versus 3.7%. They were associated with less need for kidney replacement therapy and less hyperchloremia, but whether these benefits should drive fluid choice remains an important clinical question.
- Journal
- Journal of intensive care medicine (Q1)
- Published
- 19 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Mohammed A Elbahloul, Aliaa Gamal, Bandar Alawlaqi, Ahmed F Abumezed, Mohamed Farahat, Logina Salam, et al.
- PMID
- 42895626
- DOI
- 10.1177/08850666261498038
Why clinicians should know about it
- Picked for Pediatrics and Child Health (paper of the day, 20 October 2026): Balanced fluids reduce hyperchloremia, no mortality difference
Abstract
BackgroundIn pediatric septic shock, early fluid resuscitation is a vital approach to treat this condition. The appropriate isotonic crystalloid to use (balanced salt solution [BSS] vs normal saline [NS]) remains debated. We performed an updated systematic review and meta-analysis to evaluate the safety and efficacy of both isotonic crystalloid solutions in this patient population.MethodsWe systematically searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception until May 1, 2026, for randomized controlled trials (RCTs) comparing BSS with NS for fluid resuscitation in children (<18 years) with septic shock or sepsis. The primary outcome was hospital or 30-day mortality. We synthesized data using frequentist inverse-variance random-effects models. The protocol was registered in PROSPERO (CRD420261391864), and the certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for all outcomes.ResultsSix RCTs involving 9743 participants were included. For the primary outcome, BSS and NS demonstrated no significant differences in hospital or 30-day mortality rates (3.5% vs 3.7%; RR: 0.97, 95% CI: 0.81-1.16, P = .72). Secondary analyses revealed that BSS significantly reduced the requirement for renal replacement therapy (RRT) (RR: 0.68, 95% CI: 0.47-0.97) and hyperchloremia (RR: 0.65, 95% CI: 0.57-0.75).ConclusionThe use of BSS versus NS showed no significant difference in short-term mortality among children with septic shock; however, BSS provided significant clinical and physiological advantages, including reduced incidences of hyperchloremia and the need for RRT.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.