Emergency fluid bolus therapy studies: first do no harm

Maitland, Kathryn

doi:10.1136/archdischild-2018-315885

Cited by 3 publications

(4 citation statements)

References 7 publications

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“…2 The wider relevance of these findings has been hotly debated. 2 The Fluids in Shock study is an English pilot study 3 ; it randomised 75 children presenting to emergency departments with clinical sepsis and shock persisting after a fluid bolus of 20 mL/kg, to further fluid boluses of either 10 or 20 mL/kg every 15 min for up to 4 h if still shocked. 3 Participants were not as unwell as expected, there were no deaths and the authors concluded a larger UK trial was not feasible.…”

Section: Fluid Resuscitation In Early Septic Shockmentioning

confidence: 99%

Quality of life in congenital heart disease

2019

J Paediatrics Child Health

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Quality of life in congenital heart diseaseHeroic operations are routinely offered in industrialised countries for children with severe congenital heart lesions. Parents need to know the outcome to make informed decisions about surgery. A systematic review of health-related quality of life (HRQOL) found 20 studies involving 3808 children and young adult patients with surgical congenital heart disease and 2951 parental reports. 1 Cardiac defects were grouped into simple, moderate and complex. HRQOL was worse compared to healthy controls in all domains, with the largest differences in physical functioning and psychosocial functioning. Cardiac-related HRQOL post-surgery was significantly worse in complex compared with simple congenital heart disease, particularly in terms of symptoms and cognitive function. Parents were most concerned about their children's psychosocial and emotional functioning, communication and cardiac symptoms, while patients' concerns were with physical and social functioning. The systematic review did not look at family dysfunction, including marital breakdown. All the studies were in high-income countries. This study provides valuable information for families and their medical practitioners to consider prior to surgery.

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Section: Fluid Resuscitation In Early Septic Shockmentioning

confidence: 99%

Quality of life in congenital heart disease

2019

J Paediatrics Child Health

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“…The FEAST trial, a randomised controlled trial conducted in East Africa, found surprisingly that the 48‐h and 28‐day mortality was significantly higher in children with fever and shock given a 20 mL/kg bolus of either 5% albumin or 0.9% saline than in those not given a bolus . The excess mortality was due to cardiovascular collapse . The wider relevance of these findings has been hotly debated .…”

mentioning

confidence: 99%

“…The excess mortality was due to cardiovascular collapse . The wider relevance of these findings has been hotly debated . The Fluids in Shock study is an English pilot study; it randomised 75 children presenting to emergency departments with clinical sepsis and shock persisting after a fluid bolus of 20 mL/kg, to further fluid boluses of either 10 or 20 mL/kg every 15 min for up to 4 h if still shocked .…”

mentioning

confidence: 99%

“…Participants were not as unwell as expected, there were no deaths and the authors concluded a larger UK trial was not feasible. However, an accompanying editorial points out that the lower dose of 10 mL/kg compared with 20 mL/kg was associated with a paediatric intensive care unit admission rate of 26 versus 32%, median paediatric intensive care unit stay of 45 h (interquartile range 18–143) versus 119 h (interquartile range 52–228), mechanical ventilation 11 versus 25% and use of inotropes 2.8 versus 15.6%, and argues, after an initial 20 mL/kg bolus, for a more conservative guideline of giving 10 mL/kg every 15 min.…”

mentioning

confidence: 99%

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