Fluid resuscitation therapy for paediatric sepsis

Long, Elliot; Duke, Trevor

doi:10.1111/jpc.13085

Cited by 16 publications

(9 citation statements)

References 69 publications

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“…Since publication of the FEAST trial in 2011, there has been extensive debate about the generalisability of the findings and their implications for practice 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14. The surprising finding, that a common medical intervention increased mortality in the only randomised controlled trial ever done to test fluid resuscitation against a no bolus control, has raised several important questions.…”

Section: Introductionmentioning

confidence: 99%

Effects of saline or albumin fluid bolus in resuscitation: evidence from re-analysis of the FEAST trial

Levin

Cunnington

Wilson

et al. 2019

The Lancet Respiratory Medicine

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Summary Background Fluid resuscitation is the recommended management of shock, but increased mortality in febrile African children in the FEAST trial. We hypothesised that fluid bolus-induced deaths in FEAST would be associated with detectable changes in cardiovascular, neurological, or respiratory function, oxygen carrying capacity, and blood biochemistry. Methods We developed composite scores for respiratory, cardiovascular, and neurological function using vital sign data from the FEAST trial, and used them to compare participants from FEAST with those from four other cohorts and to identify differences between the bolus (n=2097) and no bolus (n=1044) groups of FEAST. We calculated the odds of adverse outcome for each ten-unit increase in baseline score using logistic regression for each cohort. Within FEAST participants, we also compared haemoglobin and plasma biochemistry between bolus and non-bolus patients, assessed the effects of these factors along with the vital sign scores on the contribution of bolus to mortality using Cox proportional hazard models, and used Bayesian clustering to identify subgroups that differed in response to bolus. The FEAST trial is registered with ISRCTN, number ISRCTN69856593. Findings Increasing respiratory (odds ratio 1·09, 95% CI 1·07–1·11), neurological (1·26, 1·21–1·31), and cardiovascular scores (1·09, 1·05–1·14) were associated with death in FEAST (all p<0·0001), and with adverse outcomes for specific scores in the four other cohorts. In FEAST, fluid bolus increased respiratory and neurological scores and decreased cardiovascular score at 1 h after commencement of the infusion. Fluid bolus recipients had mean 0·33 g/dL (95% CI 0·20–0·46) reduction in haemoglobin concentration after 8 h (p<0·0001), and at 24 h had a decrease of 1·41 mEq/L (95% CI 0·76–2·06; p=0·0002) in mean base excess and increase of 1·65 mmol/L (0·47–2·8; p=0·0070) in mean chloride, and a decrease of 0·96 mmol/L (0·45 to 1·47; p=0·0003) in bicarbonate. There were similar effects of fluid bolus in three patient subgroups, identified on the basis of their baseline characteristics. Hyperchloraemic acidosis and respiratory and neurological dysfunction induced by saline or albumin bolus explained the excess mortality due to bolus in Cox survival models. Interpretation In the resuscitation of febrile children, albumin and saline boluses can cause respiratory and neurological dysfunction, hyperchloraemic acidosis, and reduction in haemoglobin concentration. The findings support the notion that fluid resuscitation with unbuffered electrolyte solutions may cause harm and their use should be cautioned. The effects of lower volumes of buffered solutions should be evaluated further. Funding Medical Research Council, Department for International Development, National Institute for Health Research, Imperial College Biomedical Research Centre.

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Section: Introductionmentioning

confidence: 99%

Effects of saline or albumin fluid bolus in resuscitation: evidence from re-analysis of the FEAST trial

Levin

Cunnington

Wilson

et al. 2019

The Lancet Respiratory Medicine

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“…The superiority of different isotonic crystalloid solutions to one another has not been demonstrated (8,27,28). In order to prevent hyperchloremic acidosis due to the use of 0.9% NaCl in rapid and significant volume changes, it seems reasonable to use a more isotonic stable crystalloid with content similar to the plasma electrolytes closer to physiological pH (29,30). Colloids are an option for massive and acute replacement (albumin, gelatin or hydroxyethyl-starch).…”

Section: Intraoperative Periodmentioning

confidence: 99%

Perioperative fluid management in pediatric patients

Eşki̇n¹,

Orhan²

2019

Gulhane Med J

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“…4. Некоторые показатели во время операции у пациентов в группах сравнения (M±SD) Нежелательно применение NaCl 0,9% для проведения инфузионной терапии при оперативных вмешательствах с массивной кровопотерей, поскольку это может привести к выраженному гиперхлоремическому ацидозу (содержание Cl -96-105 ммоль/л в плазме крови, а в NaCl 0,9% -154 ммоль/л) [19,20,21] и гипернатриемии (содержание Na+ в плазме крови 136-143 ммоль/л, а в NaCl 0,9% -154 ммоль/л). Инфузия большого объема также может ухудшить функцию почек, проницаемость сосудов, кислотно-основное равновесие и коагуляционные свойства крови [11].…”

Section: результаты и обсуждениеunclassified

Strategy of Infusion-Transfusion Therapy in Operations With Massive Bloodwork in Children With Tumor Abomalomal Localization Tumors

Белоусова

Матинян

Martynov

2018

jour

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Surgeries for thoracoabdominal tumors in children predispose to water and electrolyte imbalance, imbalance in the coagulation system, etc. In spite of abundance of recommendations for children, the volume of basic infusion therapy is uncertain.Study purpose. To estimate the clinical effectiveness of the conducted infusion therapy with isotonic balanced electrolyte solution in children who underwent thoracoabdominal surgeries accompanied with massive blood loss and a complex estimation of the conducted infusion and transfusion therapy.Materials and methods. The intraoperative and early postoperative (days 1–5) periods were analyzed in 22 patients (ASA II–III) who underwent an operation for thoracoabdominal malignant tumors with massive perioperative blood loss in 2016–2017. Group I included 11 patients who had infusion with balanced crystalloid solutions of 5 to 10 ml/kg/hour under combined anesthesia. Group II includes 11 patients who had infusion with balanced crystalloid solutions of 11 to 20 ml/kg/hour under combined anesthesia.Results. According to the conducted study, a higher hemodynamic stability was observed in patients from the group of basic infusion therapy with balanced crystalloid solutions of 11–20 ml/kg/hour. It was expressed as the decrease of the mean dose of the used vasopressors and volume of the infusion of colloidal solutions. The patients also had a less intense response to stress.

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Fluid resuscitation therapy for paediatric sepsis

Cited by 16 publications

References 69 publications

Effects of saline or albumin fluid bolus in resuscitation: evidence from re-analysis of the FEAST trial

Effects of saline or albumin fluid bolus in resuscitation: evidence from re-analysis of the FEAST trial

Perioperative fluid management in pediatric patients

Strategy of Infusion-Transfusion Therapy in Operations With Massive Bloodwork in Children With Tumor Abomalomal Localization Tumors

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