(909) Impact of Buffered Versus Unbuffered Fluid Therapy on Pediatric Traumatic Brain Injury Outcomes

Introduction: The use of buffered hyperosmolar fluids is increasing in the management of pediatric traumatic brain injury (TBI). Limited data suggests use of buffered fluids over unbuffered fluids may be beneficial in critically-ill patients. Evidence for this in pediatrics is inconclusive in general, and is lacking in the pediatric TBI population. The aim of this study is to determine if use of buffered fluids in pediatric TBI patients mitigates the negative effects of hyperchloremic acidosis, acute kidney injury, and higher in-hospital mortality associated with unbuffered fluids.

Methods: This is a single-center, retrospective chart review of patients age 0-18 admitted to a Level 1 Pediatric Trauma Center for over 24 hours with a diagnosis of TBI, who received hyperosmolar therapy. The primary outcomes include presence of acute kidney injury, degree of hyperchloremia, and metabolic acidosis. Secondary outcomes include survival to discharge, total ventilator days, and Glasgow Outcome Scale post discharge. Average daily dose in milliliters per kilogram of crystalloid therapies were measured over the first seven days of admission. We conducted multiple linear regression and multivariate logistic regression to determine the association between average daily doses of isotonic and hypertonic buffered and unbuffered fluids with the outcomes above, adjusting for initial GCS score and age at admission.

Results: 100 patients were included in our dataset. All patients received unbuffered fluids. 32 patients received some type of buffered fluid, hypertonic or isotonic. We found no significant associations between the outcomes of interest and those who on average had received more buffered fluids per kilogram per day compared to unbuffered fluid therapies.

Conclusions: Use of buffered versus unbuffered fluids in the pediatric TBI population yielded similar degrees of electrolyte and acid-base disturbances, incidence of acute kidney injury, and long-term mortality and morbidity. There is no clear difference in outcomes with respect to fluid composition in pediatric TBI. Existing evidence in favor of use of buffered over unbuffered crystalloids in critically ill patients may not apply to the pediatric TBI population. However, this study is limited by sample size.