P0181 / #1250: BALANCED VERSUS UNBALANCED FLUID IN CRITICALLY-ILL CHILDREN: SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Aims & Objectives: The ideal isotonic crystalloid fluid bolus therapy remains unclear. Administration of 0.9% saline has been associated with hyperchloremic metabolic acidosis and acute kidney injury (AKI). Few adult trials have found more favourable outcomes with balanced fluids, but pediatric data is limited and inconsistent. The objective this study was to compare balanced versus unbalanced fluid bolus therapy on metabolic acidosis in critically-ill children. Methods: Using the PRISMA-P guidelines, we retrieved all controlled trials and cohort studies comparing balanced and unbalanced resuscitative fluids in critically-ill children. The primary outcome was the incidence and/or time to resolution of metabolic acidosis defined as a serum pH<7.35 or serum bicarbonate level<20 mmol/L. Secondary outcomes included the incidence of hyperchloremia, AKI, renal replacement therapy (RRT) and mortality. Study screening, inclusion, data extraction and assessment of risk of bias were performed independently by two authors. Results: Among 357 references identified, 10 met inclusion criteria. We found higher change in bicarbonate serum level (pooled estimate 1.67; 95%CI -0.02 to 3.36; I2=98.33%; p=0.0521; NNT=1.20), pH level (pooled mean difference 0.03; 95%CI-0.01 to 0.05; I2=0.42%; p=0.0020; NNT=1.41). No difference was found in AKI, RRT and mortality. Conclusions: Our systematic review found some evidence of improved metabolic acidosis in critically-ill children after fluid bolus therapy with balanced fluid compared to the unbalanced fluid. However, a randomized controlled trial is needed to establish whether these findings have an impact on clinical outcomes before recommendations can be generated.