{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T03:11:51Z","timestamp":1792465911049,"version":"4.5.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,2,23]],"date-time":"2025-02-23T00:00:00Z","timestamp":1740268800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      <jats:bold>Objective:<\/jats:bold>\n                      Fluid resuscitation is an important intervention in children with septic shock. The composition of resuscitation fluid is a matter of debate. Our aim was to study the effects of balanced salt solution\n                      <jats:bold>(<\/jats:bold>\n                      BSS) versus normal saline (NS) for resuscitation in pediatric septic shock.\n                      <jats:bold>Data sources:<\/jats:bold>\n                      We searched MEDLINE, Embase, LILAC, Cochrane Collaboration, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform.\n                      <jats:bold>Study selection:<\/jats:bold>\n                      Two independent authors screened title and abstracts and then full papers of included studies.\n                      <jats:bold>Data extraction:<\/jats:bold>\n                      Two authors extracted data from full papers independently. Random-effects model was used for analysis of RCTs. We used Cochrane's risk of bias tool for assessing the quality of studies. Primary outcome was mortality and secondary outcomes were rates of acute kidney injury (AKI), need for renal replacement therapy (RRT), and adverse effects (hyperchloremia, metabolic acidosis, and fluid overload); and duration of PICU and hospital stay.\n                      <jats:bold>Data synthesis:<\/jats:bold>\n                      Five RCTs with 992 children were included. Resuscitation with BSS versus NS was not associated with reduction in mortality (RR 0.82, 95% CI 0.45-1.50, p\u2009=\u20090.52; RCTs\u2009=\u20095); with similar results on sensitivity analysis (RR 0.76, 95% CI 0.41-1.41, p\u2009=\u20090.52; 4 RCTs\u2009=\u20094). However, resuscitation with BSS was associated with lower rates of AKI (sensitivity analysis RR 0.64, 95% CI 0.50-0.82, p\u2009=\u20090.0004; RCTs\u2009=\u20093); lesser need for RRT (RR 0.52, 95% CI 0.35-0.76, p\u2009=\u20090.0008; RCTs\u2009=\u20092); and lower rate of hyperchloremia (RR 0.74, 95% CI 0.62-0.87, p\u2009=\u20090.0002; RCTs\u2009=\u20093). The data is scant for other secondary outcomes (metabolic acidosis, fluid overload, and duration of PICU and hospital stay) to make any suggestions. The overall \u2018risk of bias\u2019 was low and unclear in most domains.\n                      <jats:bold>Conclusion:<\/jats:bold>\n                      Use of BSS as resuscitation fluid in pediatric septic shock was not associated with reduction in mortality. However, BSS was associated with decreased risk of AKI, need of RRT and hyperchloremia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration (if any)<\/jats:title>\n                    <jats:p>PROSPERO (CRD42022332208).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08850666251315705","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T02:25:52Z","timestamp":1740363952000},"page":"274-283","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Balanced Salt Solution Versus Normal Saline as Resuscitation Fluid in Pediatric Septic Shock: A Systematic Review and Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.1177","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9706-0103","authenticated-orcid":false,"given":"Sudha","family":"Chandelia","sequence":"first","affiliation":[{"name":"PGIMER"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6370-8258","authenticated-orcid":false,"given":"Suresh Kumar","family":"Angurana","sequence":"additional","affiliation":[{"name":"PGIMER"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shankar","family":"Prasad","sequence":"additional","affiliation":[{"name":"PGIMER"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mithlesh Kumar","family":"Tiwari","sequence":"additional","affiliation":[{"name":"PGIMER"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6149-1355","authenticated-orcid":false,"given":"Muralidharan","family":"Jayashree","sequence":"additional","affiliation":[{"name":"PGIMER"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthi","family":"Nallasamy","sequence":"additional","affiliation":[{"name":"PGIMER"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6212-6889","authenticated-orcid":false,"given":"Arun","family":"Bansal","sequence":"additional","affiliation":[{"name":"PGIMER"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,2,23]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(18)30063-8"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(14)71003-5"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-021-02686-0"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000001222"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-019-05878-6"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0000000000000119"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-011-1559-6"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/SHK.0000000000001468"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13049-022-01015-3"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00024382-199805000-00009"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318256be72"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-018-5424-1"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.21037\/atm.2017.07.38"},{"issue":"7","key":"e_1_3_3_15_2","article-title":"Buffered solutions versus 0.9% saline for resuscitation in critically ill adults and children","volume":"7","author":"Antequera Mart\u00edn AM","year":"2019","unstructured":"Antequera Mart\u00edn AM, Mendoza B, A J, et al. Buffered solutions versus 0.9% saline for resuscitation in critically ill adults and children. Cochrane Database Syst Rev. 2019;7(7):CD012247.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000002890"},{"issue":"2","key":"e_1_3_3_17_2","first-page":"295","article-title":"Balanced crystalloids versus isotonic saline in pediatric sepsis: A comprehensive systematic review and meta-analysis","volume":"37","author":"Mhanna A","year":"2024","unstructured":"Mhanna A, Beran A, Srour O, et al. Balanced crystalloids versus isotonic saline in pediatric sepsis: A comprehensive systematic review and meta-analysis. 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Comparison of a balanced electrolyte solution with normal saline as resuscitation fluid in children. (CTRI\/2021\/04\/033284). Accessed from https:\/\/trialsearch.who.int\/Trial2.aspx?TrialID=CTRI\/2021\/04\/033284. On 18 April 2024."},{"key":"e_1_3_3_29_2","unstructured":"Sharma M. Lactated Ringers versus Normal Saline in initial fluid resuscitation in Children with septic shock - A Randomized Controlled Trial. Accessed from https:\/\/trialsearch.who.int\/Trial2.aspx?TrialID=CTRI\/2022\/12\/048504. On 18 April 2024."},{"key":"e_1_3_3_30_2","unstructured":"Tabrizi M. Evaluation of therapeutic outcome of ringer lactate in treatment of acute resuscitation phase of severe dehydration children a randomized clinical trial. Accessed from https:\/\/trialsearch.who.int\/Trial2.aspx?TrialID=IRCT20210201050199N2. On 18 April 2024."},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2017-314584.29"},{"key":"e_1_3_3_32_2","unstructured":"Jayashree M. 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