@misc{10818/53196,
year = {2021},
month = {4},
url = {http://hdl.handle.net/10818/53196},
abstract = {Objective: To evaluate the outcomes of patients with sepsis-associated organ dysfunction and septic shock who receive fluid
resuscitation with balanced and unbalanced solutions in a middle-income country. Design: An observational, analytical cohort
study with propensity score matching (PSM) in children admitted to a pediatric intensive care unit (PICU). Patients from one
month to 17 years old who required fluid boluses due to hemodynamic instability were included. The primary outcome was the
presence of acute kidney injury and the secondary outcomes were the need to begin continuous renal replacement therapy
(CRRT), metabolic acidosis, PICU length of stay and mortality. Measurements and Main Results: Out of the 1,074 admissions
to the PICU during the study period, 99 patients had sepsis-associated organ dysfunction and septic shock. Propensity score
matching was performed including each patient´s baseline characteristics. The median age was 9.9 months (IQR 4.9-22.2) with
55.5% of the patients being male. Acute kidney injury was seen less frequently in children who received a balanced solution than in
those who received an unbalanced solution (20.3% vs 25.7% P ¼ 0.006 ORa, 0.75; 95% CI, 0.65-0.87), adjusted for disease severity.
In addition, the group that received balanced solutions had less need for CRRT (3.3 % vs 6.5%; P ¼ 0.02 ORa 0.48; 95% CI,
0.36-0.64) and a shorter PICU stay (6 days IQR 4.4-20.2 vs 10.2 days IQR 4.7-26; P < 0.001) than the group with unbalanced
solutions. We found no difference in the frequency of metabolic acidosis (P ¼ 0.37), hyperchloremia (P ¼ 0.11) and mortality
(P ¼ 0.25) between the 2 groups. Conclusion: In children with sepsis-associated organ dysfunction and septic shock, the use of
unbalanced solutions for fluid resuscitation is associated with a higher frequency of acute kidney injury, a greater need for
continuous renal support and a longer PICU stay compared to the use of balanced solutions, in a middle-income country},
publisher = {Journal of Intensive Care Medicine},
title = {Association between unbalanced solutions and acute kidney injury during fluid resuscitation in children with sepsis},
doi = {10.1177/08850666211004453},
author = {Fernández-Sarmiento J. and Alcalá-Lozano C. and Barrera PA. and Erazo Vargas SC. and Gómez Cortes LB. and Reyes C M.},
}