Impact of Hypertonic Lactated Saline Resuscitation on Serum Interleukin-6 (IL-6) Level in Pediatric Severe Sepsis/Septic Shock in Developing Country

Background: Fluid rescucitation with normal saline (NS) could aggravate IL-6 production. Our objective was to compare impact of small volume resuscitation hypertonic lactated saline (HLS) versus NS in pediatric severe sepsis/septic shock in developing country hospital setting. The primary endpoint was the decrease of serum IL-6 level after 6 and 12 hours fluid resuscitation. The secondary endpoint was fluid overload. Methodology and principal findings: A preand post-design, repeated measure study including 30 severe sepsis/septic shock children was conducted in Hasan Sadikin Hospital Bandung, Indonesia. Newly diagnosed severe sepsis/septic shock children (>12−168 months old) were eligible. Patients were resuscitated with either HLS (bolus of 5 mL/kgBW, repeated if no response and followed with 1 mL/kgBW/hour for 12 hours), or NS (bolus of 20 mL/kgBW, repeated if no response and followed with maintenance fluid requirement). If shock persisted inotropes and/or cathecolamine were commenced. There were no significant difference of serum IL-6 levels between groups over time (p=0.183). HLS group had significant lower fluid balance than NS group (p<0.001). Conclusions: There was no impact of HLS on serum IL-6 levels after 6 and 12 hours fluid resuscitation. As lower fluid overload observed in HLS group, HLS solution may likely to be a promising fluid for resuscitation in severe sepsis/septic shock children.