African fluid bolus study: Implications for practice

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.