Asociación entre uso de soluciones balanceadas y lesión renal durante la reanimación hídrica en niños con sepsis

Abstract

Objective. To establish the association between the administration of balanced an unbalanced crystalloid with different results such as acute kidney injury, metabolic acidosis and hyperchloremia, in children with severe sepsis and septic shock hospitalized in the PICU and in the cardiovascular PICU of the Fundación CardioInfantil. Type of study. Retrospective observational cohort. Patients. A cohort of patients from 1 month to 17 years of age, with severe sepsis and septic shock, who are hospitalized in the PICU and in the C-PICU of the Fundación CardioInfantil, from April 1/2018 to April 30/2019, and that received balanced and unbalanced crystalloids for hemodynamic stabilization, was collected. The association between the crystalloid type (balanced and unbalanced) and different outcome (acute kidney injury metabolic acidosis and hyperchloremia) was evaluated. Interventions. None. Results. Of 1074 patients hospitalized in the PICU and the C-PICU in the observation period, were included 103 patients with severe sepsis and septic shock, with an average age of 15 months old and a greater percentage of males. The mean length of stay in the PICU was 7.5 days. The most frequent infections were the respiratory, and secondly, the gastrointestinal ones (54.4% and 24.3%, respectively). It was found that 47.2% of patients who received unbalanced crystalloids developed acute renal injury (p<0.003), and of them, 16.7% required extracorporeal renal support (p<0.002). The mortality to the day 28 was significantly lower (7.6% vs 25.7%; p=0.02 respectively). There were no differences in the development of metabolic acidosis (p=0.84) and hyperchloremia (p=0.12) between the groups. Conclusion. The administration of balanced crystalloids was associated with a lower rate of acute kidney injury in children with severe sepsis and septic shock, and secondly, with a lower need for extracorporeal renal support and mortality rate.