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Intensive care treatment should be used with same caution as a lethal drug

Children who are given fluid to treat shock have an increased risk of death due to cardiovascular collapse at 48 hours according to the results from the Fluid Expansion as Supportive Therapy clinical trial in East Africa published in BMC Medicine on 14 March.

The findings of the FEAST trial are surprising given that this treatment is standard practice elsewhere.

The research team involved in this trial believe that in settings where there is a lack of intensive care facilities 'standard' procedures, such as fluid resuscitation, should not necessarily be used, especially when they have not been properly tested in clinical trials.

Professor John Myburgh AO of The George Institute for Global Health take this one stage further and recommends that fluid resuscitation should be used with the same care as any potentially lethal drug.

"Studies are beginning to show cracks in fluid resuscitation therapy and that careful monitoring is needed as well as a better understanding of dose and the way the therapy is given," Professor Myburgh says.

"The compelling results of this study from Africa question the wisdom of fluid bolus as therapy not only in pediatric patients but also in all critically ill patients," he says.

The findings of the FEAST trial provide unique insights into a critically important area of clinical medicine and challenge many established principles about using intravenous fluids for resuscitation.

In a commentary on the FEAST trial published in BMC Medicine, Professor Myburgh and Professor Finfer of The George Institute say, "it is imperative that clinicians carefully consider the type, dosing and rate of administration of resuscitation fluids and monitor their effects beyond the initial resuscitation period."

"Fluid resuscitation is under increasing scrutiny following the publication of a number of randomized controlled trials questioning the safety and efficacy of widely used resuscitation fluids", they say.

"The FEAST trial showed that febrile children with impaired perfusion treated in low-income countries without access to intensive care are more likely to die if they receive bolus resuscitation with albumin or saline compared with no bolus resuscitation at all."