Fluids and Kids: What Now?

The only controlled trial of fluid resuscitation, Fluid Expansion as Supportive Therapy (FEAST), involving 3141 African children with severe febrile illness, including large groups with sepsis and malaria, called into question aggressive fluid resuscitation, demonstrating excess mortality in both bolus arms (albumin and saline) compared to no-bolus control, relative risk of morality in bolus versus control was 1.45 (1.13-1.86, p=0.003)
Four years have elapsed since the publication of FEAST, yet World Health Organization continues to recommend fluid boluses for children managed in resource-poor hospitals, where there is no access to intensive care. In Africa alone, where one in 10 febrile child admissions present with shock, we have estimated that the current guidelines, if fully implemented, will result in ~5,600 and 33,000 excess deaths each year per million hospital admissions treated for shock.