S01E40 | Balanced Fluids vs Saline in Pediatric Septic Shock: Why Adult ICUs Should Care

This week on PRISM Rounds, we discuss the April 2026 New England Journal of Medicine PRoMPT BOLUS trial comparing balanced crystalloids with 0.9% saline in children treated for suspected septic shock.The trial enrolled more than 9,000 children across 47 emergency departments and found no significant difference in major adverse kidney events between balanced fluid and saline. Balanced fluids reduced hyperchloremia and hypernatremia, but those biochemical advantages did not translate into better kidney outcomes, mortality, or hospital-free days.Although this is a pediatric trial, it is relevant for adult ICU and ED clinicians because it speaks to a familiar bedside question: when we reach for crystalloid early in sepsis, does fluid type meaningfully change patient-centered outcomes?We connect this trial to adult sepsis resuscitation, prior fluid-choice studies, and the broader lesson that “more physiologic” does not always mean “better outcomes.”Article: Balanced Fluid or 0.9% Saline in Children Treated for Septic ShockDOI: https://doi.org/10.1056/NEJMoa2601969Educational only; not medical advice. This episode uses AI-generated voices. #PRISMRounds#CriticalCare#ICU#EmergencyMedicine#Sepsis#SepticShock#PediatricSepsis#BalancedCrystalloids#NormalSaline#FluidResuscitation#Resuscitation#KidneyOutcomes#MAKE30#NEJM#EvidenceBasedMedicine#MedicalEducation#FOAMed#FOAMcc#PulmonaryCriticalCare#AIgenerated#AIResearchSummary#FreeMedicalEducation#JournalClub#BedsideMedicineTags / Hashtags