Historical collection · First published Apr 23, 2026; added to EM Weekly Oct 27, 2026. This retrospective summary may be superseded by later evidence or guidance.
← All articlesBalanced Fluid or 0.9% Saline in Children Treated for Septic Shock
Summary
In this pragmatic trial at 47 EDs, balanced fluid and saline produced similar major adverse kidney event rates in children treated for suspected septic shock. Of 9,041 enrolled, 8,482 remained for analysis after withdrawal without permission to use data.
Why it matters
Balanced fluids reduced some electrolyte abnormalities but did not demonstrate a patient-centered renal benefit. This later trial should be considered alongside the very-low-certainty preference for balanced fluids in March 2026 pediatric sepsis guidance.
Study at a glance
- Design
- Randomized trial
- Population
- Children aged two months to under 18 years with suspected septic shock and abnormal perfusion at EDs in five countries.
- Sample size
- 8482
- Intervention
- Balanced crystalloids for resuscitation and maintenance for up to 48 hours.
- Comparator
- 0.9% saline.
- Primary endpoint
- Death, new kidney replacement therapy, or persistent kidney dysfunction by day 30 or hospital discharge.
Main findings
- MAKE30: 3.4% versus 3.0%; RR 1.10 (95% CI 0.88-1.40).
- Hyperchloremia was less frequent with balanced fluids.
Limitations
Unblinded fluid assignment, missing laboratory measurements, and low primary-event frequency limit interpretation. A neutral superiority trial does not prove all fluid choices equivalent.
Read the primary source
Full text: Open-access full text available.
Original sourcePMID: 42028918
Material reviewed: abstract.
Source retrieved Oct 27, 2026. Indexed legal PMC13134814 abstract and selected methods reviewed, not complete full text. Publisher History explicitly gives April 23 online publication; PubMed/manuscript date April 24 was not used as first-online. Publisher title uses “or”; manuscript title uses “versus”.
Corrections & review history
No corrections recorded. Human review: not yet human-reviewed.