A major international clinical trial has found that two commonly used intravenous fluids are equally effective for resuscitating children with septic shock—a life-threatening response to severe infection.
Children’s Hospital Los Angeles researchers co-authored the landmark study, which was published in The New England Journal of Medicine and enrolled more than 9,000 pediatric patients across five countries.
In all, 47 centers participated in the trial, including CHLA, which is home to a designated Level 1 Pediatric Trauma Center. It was conducted through the Pediatric Emergency Care Applied Research Network (PECARN), a federally funded research network in which CHLA is an active leader.
“These findings help resolve an important and long-debated clinical question,” says Pradip Chaudhari, MD, MS, Director of Research and Scholarship for Emergency and Transport Medicine at Children’s Hospital Los Angeles. “The results are expected to directly inform clinical practice, potentially improving consistency in care and reducing unnecessary variation in decision-making.”
A long-debated question
Septic shock is a medical emergency that requires rapid decision‑making in the emergency department—including which IV fluids to use.
While both balanced crystalloid fluids and 0.9% saline fluids are routinely available and widely used, evidence comparing their effects in children has been limited. This has fueled ongoing debate, with some clinicians believing balanced fluids might offer meaningful safety advantages since they more closely resemble human plasma.
However, the trial found that both fluids are appropriate and effective options for initial pediatric emergency care. Researchers found no significant differences between either option in rates of major adverse kidney events or mortality. Further, the choice of fluid did not affect the number of hospital-free days.
“The results provide reassurance that either fluid can be used safely and effectively, allowing clinicians to prioritize timely care in emergency settings,” says Ara Festekjian, MD, MS, Quality Improvement Director for Emergency and Transport Medicine and a study co-author.
The findings are particularly important for children with complex medical conditions whose underlying illnesses and treatments place them at higher risk for developing septic shock.
Shaping pediatric care
At CHLA, the study was a multidisciplinary collaboration between the Emergency Department, Critical Care Medicine, Hospital Medicine, Oncology, and Gastroenterology. The trial also highlights CHLA’s continued role in contributing to high‑impact national and international research that shapes pediatric care.
“Participating in large‑scale studies like this through PECARN allows CHLA to help generate evidence that directly informs clinical practice,” Dr. Chaudhari adds. “Ultimately, this work supports more consistent, evidence‑based care for critically ill children.”