Global PRoMPT BOLUS Trial Finds Balanced Fluids and Saline Equally Effective for Pediatric Septic Shock

A major study from CHOP confirms that saline and balanced fluids are equally effective for treating pediatric sepsis, providing global emergency teams more options.

By: AXL Media

Published: Apr 24, 2026, 6:40 AM EDT

Source: Information for this report was sourced from EurekAlert!

Equivalent Outcomes in Emergency Fluid Resuscitation

A landmark international study has resolved a long-standing debate in pediatric emergency medicine by confirming that the two most common intravenous fluids used for sepsis resuscitation are equally effective. Led by the Children’s Hospital of Philadelphia, Nemours Children’s Health, and Children’s National Hospital, the PRoMPT BOLUS trial examined whether balanced fluids, which mimic human plasma, outperformed traditional 0.9% saline. The results, presented at the Pediatric Academic Societies Meeting in Boston, demonstrate that neither fluid type significantly reduces the risk of major adverse kidney events or mortality. This finding provides critical flexibility to clinicians worldwide, allowing them to use whichever fluid is most readily available during the life-threatening window of septic shock.

The Scale of the Pediatric Sepsis Challenge

Sepsis remains a primary driver of pediatric hospitalization, affecting more than 18,000 children annually in the United States alone. The condition arises from an abnormal immune response to infection that leads to rapid organ failure, with approximately 10% of pediatric cases resulting in death. While previous research in critically ill adults suggested that balanced crystalloids might reduce the risk of death and complications compared to saline, those findings did not necessarily apply to the unique physiology of children. According to Dr. Fran Balamuth, Division Chief of Emergency Medicine at CHOP, the research team recognized that thousands of patients across a global network would be required to definitively answer if a superior fluid existed for the younger population.

Global Collaboration Through Specialized Research Networks

To achieve the necessary data standards, the study utilized the Pediatric Emergency Care Applied Research Network (PECARN), a federally funded group of 18 hospitals in the United States. The collaboration eventually expanded to include 47 emergency departments across five countries, including Canada, Australia, New Zealand, and Costa Rica. This massive infrastructure allowed for the enrollment of more than 9,000 pediatric patients, making it one of the largest clinical trials of its kind. Senior author Nathan Kuppermann noted that such large-scale collaborative networks are essential for providing the evidence-based guidelines tha...