Explorez tous les épisodes du podcast The PEM Podcast

Does the type of crystalloid we choose change outcomes for children with septic shock?

Dr. Bob Belfer speaks with pediatric intensivist and sepsis researcher Dr. Scott Weiss about the landmark PRoMPT BOLUS trial, which compared balanced crystalloids with 0.9% saline in more than 9,000 children.

They discuss why fluid boluses help - and why their effects may be temporary - the meaning of the MAKE30 outcome, how the trial’s findings should influence fluid choice in the ED and ICU, and why lower rates of hyperchloremia did not translate into better patient-centered outcomes. They also review the 2026 pediatric Surviving Sepsis guidelines, including sepsis screening, the timing and selection of vasoactive medications, lactate and procalcitonin, point-of-care ultrasound, and the emerging role of AI and precision medicine in pediatric sepsis.

Balamuth F, Weiss SL, Long E, et al. Balanced fluid or 0.9% saline in children treated for septic shock. N Engl J Med. Published online April 24, 2026.

Weiss SL, Balamuth F, Long E, et al. PRagMatic Pediatric Trial of Balanced vs nOrmaL Saline FlUid in Sepsis: study protocol for the PRoMPT BOLUS randomized interventional trial. Trials. 2021;22(1):776.

Weiss SL, Keele L, Balamuth F, et al. Crystalloid fluid choice and clinical outcomes in pediatric sepsis: a matched retrospective cohort study. J Pediatr. 2017;182:304-310.e10.

Lehr AR, Rached-d’Astous S, Barrowman N, et al. Balanced versus unbalanced fluid in critically ill children: systematic review and meta-analysis. Pediatr Crit Care Med. 2022;23(3):181-191.

Self WH, Semler MW, Wanderer JP, et al. Balanced crystalloids versus saline in noncritically ill adults. N Engl J Med. 2018;378(9):819-828.

Semler MW, Self WH, Wanderer JP, et al. Balanced crystalloids versus saline in critically ill adults. N Engl J Med. 2018;378(9):829-839.

Zampieri FG, Machado FR, Biondi RS, et al. Effect of intravenous fluid treatment with a balanced solution vs 0.9% saline solution on mortality in critically ill patients: the BaSICS randomized clinical trial. JAMA. 2021;326(9):818-829.

Finfer S, Micallef S, Hammond N, et al. Balanced multielectrolyte solution versus saline in critically ill adults. N Engl J Med. 2022;386(9):815-826.

Delgado Moya FP, Antequera A, Muriel A, et al. Buffered solutions versus 0.9% saline for resuscitation in critically ill adults and children. Cochrane Database Syst Rev. 2026;4(4).

Weiss SL, Peters MJ, Alhazzani W, et al. Surviving Sepsis Campaign international guidelines for the management of sepsis and septic shock in children 2026. Intensive Care Med. 2026;52(5):937-983.

Weiss SL, Peters MJ, Alhazzani W, et al. Executive summary: Surviving Sepsis Campaign international guidelines for the management of sepsis and septic shock in children 2026. Pediatr Crit Care Med. 2026;27(4):494-513.

Scott HF, Sevick CJ, Colborn KL, et al. Clinical Decision Support for Septic Shock in the Emergency Department: A Cluster Randomized Trial. Pediatrics. 2025;156(1):e2024069478.

Ventura AMC, Shieh HH, Bousso A, et al. Double-blind prospective randomized controlled trial of dopamine versus epinephrine as first-line vasoactive drugs in pediatric septic shock. Crit Care Med. 2015;43(11):2292-2302.

Ramaswamy KN, Singhi S, Jayashree M, Bansal A, Nallasamy K. Double-blind randomized clinical trial comparing dopamine and epinephrine in pediatric fluid-refractory hypotensive septic shock. Pediatr Crit Care Med. 2016;17(11).

Eisenberg MA, Carlson L, Graham DA, et al. Epinephrine vs norepinephrine as initial treatment in children with septic shock. JAMA Netw Open. 2025;8(4).

Dr. Scott Weiss is the Division Chief of Critical Care Medicine at Nemours Children’s Hospital. His clinical and translational research focuses on pediatric sepsis, including mitochondrial dysfunction, fluid resuscitation, biomarkers, and precision medicine.

The PEM Podcast features thoughtful conversations, practical teaching, and the people and ideas shaping pediatric emergency medicine. It is hosted by Dr. Bob Belfer and is part of HipPEMcrates, an independent pediatric emergency medicine education platform.

Visit HipPEMcrates.com for pediatric emergency medicine articles, literature reviews, clinical pearls, and educational resources.

The podcast is back - with a new name and a new season of conversations.

Dr. Bob Belfer introduces The PEM Podcast, formerly the CHOP PEM Podcast, and shares what listeners can expect from its return: thoughtful conversations, practical teaching, and insights from the people shaping pediatric emergency medicine. Upcoming episodes will feature national and international experts discussing pediatric sepsis, fluid management, and much more.

The PEM Podcast is now part of the HipPEMcrates network, an independent pediatric emergency medicine education platform. If you’re already subscribed, there’s nothing you need to do - new episodes will appear right here in your feed.

We’re glad to be back. Stay tuned.

Mental Health Emergencies featuring Dr. Jeremy Esposito

Take Care of Maya

Monday Morning Quarterback: COVID with Dr. Paul Offit

Abusive Head Trauma: From the ER to the courtroom with Dr. Cindy Christian

Debriefing with Dr. Lauren Zinns

PEM Boards: Pearls from Dr Craig Huang

PECARN Head Trauma - an update with Drs. Peter Dayan and Nate Kuppermann

Listen to experts discuss the breadth and depth of this complex field of medicine. (Part 1)

Eron Friedlaender, MD shares her expertise as a physician and parent in caring for

the child with autism in the Emergency Department 

Dr. Bob Belfer discusses the treatment of SEVERE ASTHMA with experts Dr. Joe Zorc [PEM] and Dr. Aaron Donoghue [PEM, PICU]

A Sweet New Year to All -- DKA with Drs. Glaser and Kuppermann kicks off 2022

 Stay a-HEAD of the game as host Dr. Bob Belfer discusses CONCUSSIONS with Dr. Dan Corwin [PEM] and Dr. Christina Master [Sports Medicine]

BREAKING NEWS EPISODE: Dr. Paul Offit rejoins us to speak about vaccines for 5-11 year olds!

RSV is back! Join host Dr. Bob Belfer as he talks Bronchiolitis with Dr. Joe Zorc [PEM]

Dr. Bob Belfer talks POCUS IN PEM with experts Dr. Rachel Rempell [CHOP] and Dr. Adam Sivitz [Children's Hospital of NJ]

Host Dr. Bob Belfer and Dr. Ron Berant [ PEM - Schneider Children's Medical Center] discuss how Israel is "Living with Covid"

Host Dr. Bob Belfer "practices" SIMULATION with Drs. Marc Auerbach [Yale PEM] and Khoon-yen Tay [CHOP PEM]

Dr. Todd Florin wins the GOLD MEDAL for his discussion with host Dr. Bob Belfer on PNEUMONIA

Dr. Bob Belfer discusses Sudden Infant Death Syndrome with Dr. Rachel Moon; intro by Dr. Stephen Ludwig

BUCKLE UP! Host Dr. Bob Belfer talks Pediatric Transport with Drs. Nicholas Tsarouhas

[CHOP PEM] and Corina Noje [JHU PICU]

Drs. Diane Calello and Kevin Osterhoudt "TALK TOX" with host Dr. Bob Belfer

Sickle cell disease experts Drs. Angela Ellison [PEM] and Kim Smith-Whitley [Heme] join host Dr. Bob Belfer as they discuss advances in the care of children with this disease.

Join host Dr. Bob Belfer as he talks to PEM experts Dr. Rich Scarfone and Dr. Prashant Majahan about how to approach the infant with a fever.  

Do not MISS this episode as Dr. Bob Belfer chats MIS-C with Dr. Josh Rocker [PEM], Dr. Hamid Bassiri [ID] and Dr. Katie Chiotos [PICU]

Join host Dr. Bob Belfer as he talks "Blunt Abdominal Trauma" with guests Dr. Eron Friedlaender [PEM], Dr. Summer Kaplan [RAD] and Dr. Michael Nance [SURG].

Join host Dr. Bob Belfer as he talks PEDIATRIC SEPSIS with Dr. Scott

Weiss [PICU], Dr. Fran Balamuth [PEM] and PEM RN Mary Kate Abbadessa

Join host Dr. Bob Belfer as he talks APPENDICITIS with Dr. Mark Joffe [PEM], Dr. Asef Khwaja [Radiologist] and Dr. Gary Nace [Surgeon]. 

Join host Dr. Bob Belfer as he chats with Dr. Jim Chamberlain [PEM] and Dr. Dennis Dlugos [Neurologist]

Dr. Paul Offit discusses his latest book, OVERKILL: When Modern Medicine Goes Too Far and COVID Updates from the Expert

Dr. Steve Ludwig and Dr. Fred Henretig introduce the CHOP PEM Podcast debuting January 2021!