African fluid bolus study: Implications for practice
Article first published online: 12 MAR 2012
© 2012 The Author. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
Journal of Paediatrics and Child Health
Volume 48, Issue 7, pages 548–550, July 2012
How to Cite
Brewster, D. (2012), African fluid bolus study: Implications for practice. Journal of Paediatrics and Child Health, 48: 548–550. doi: 10.1111/j.1440-1754.2012.02431.x
- Issue published online: 3 JUL 2012
- Article first published online: 12 MAR 2012
- Accepted for publication 6 October 2011.
- general paediatrics;
- international child health.
The Fluid Expansion as Supportive Therapy (FEAST) trial in an African setting without intensive care facilities found that bolus fluid therapy for severe infections (including malaria and viral infections) resulted in a significantly higher mortality than those not given a bolus. This was a high-quality study of 3170 children with 48 h mortality as the primary outcome. Despite the different setting and diseases than in a developed country context, it could be argued that this study calls into question the wisdom of bolus fluid regimes for sepsis, and perhaps even the concept of ‘compensated shock’ in the Advanced Paediatric Life Support protocol. Some have tried to attack the ethics of the study, but this is unjustified. The implications for paediatric practice in Africa are that intravenous fluids need to be monitored more closely, and the practice of giving boluses to every ‘query septic infant and child’ needs to be examined more critically.