Shock treatment can kill: Clinical trial shows how 'standard' procedure results in children's deaths

March 13, 2013

Results from the Fluid Expansion as Supportive Therapy (FEAST) trial in East Africa show that children who are given fluid to treat shock have an increased risk of death due to cardiovascular collapse at 48 hours. These findings in BioMed Central's open access journal BMC Medicine challenge the generally held idea that early and rapid reversal of shock by fluid resuscitation translates into longer-term survival benefits.

The FEAST trial was conducted in six African hospitals across Kenya, Tanzania and Uganda without facilities. It included 3000 children with shock caused by conditions including and malaria but excluded children with , burns, who had undergone surgery or had severe malnutrition. All the children in the trial received standard treatments, depending on their illness including antibiotics, antimalarials, anticonvulsants, glucose or whole blood if anemic, but were randomly assigned to receiving fluid resuscitation or to a control group without fluid resuscitation.

Prof Kathryn Maitland, from the Wellcome Trust Centre for Clinical Tropical Medicine at Imperial College London, who led this study explained, "The children who were given this treatment (boluses) initially responded well compared to the control group. However, this did not translate into a better recovery at 48 hours - more children died in the group receiving boluses. The main cause of death, rather than fluid overload, was ."

This is 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.

Commenting on this study Prof John Myburgh, from the University of and The George Institute for Global Health, takes 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. 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."

This article marks the launch of an article collection on Medicine for in BMC Medicine. The collection will focus on public health initiatives, the development of health care policies, management of infectious and non-communicable diseases, cost-effectiveness studies and evidence-based guidelines which are needed to address the global burden of disease.

Explore further: African trial questions emergency treatment of children in shock

More information: Exploring mechanisms of excess mortality with early fluid resuscitation: insights from the FEAST trial, Kathryn Maitland, Elizabeth C George, Jennifer A Evans, Sarah Kiguli, Peter Olupot-Olupot, Samuel O Akech, Robert O Opoka, Charles Engoru, Richard Nyeko, George Mtove, Hugh Reyburn, Bernadette Brent, Julius Nteziyaremye, Ayub Mpoya, Natalie Prevatt, Cornelius M Dambisya, Daniel Semakula, Ahmed Dungu, Vincent Okunny, Ronald Wokulira, Molline Timbwa, Benedict Otii, Michael Levin, Jane Crawley, Abdel G Babiker, Diana M Gibb and FEAST trial group BMC Medicine 2013, 11:68 doi:10.1186/1741-7015-11-68

Commentary: Causes of death after fluid bolus resuscitation: new insights from FEAST, John Myburgh and Simon Finfer, BMC Medicine 2013, 11:67 doi:10.1186/1741-7015-11-67

Related Stories

African trial questions emergency treatment of children in shock

May 27, 2011
Giving fluids rapidly through a drip into a vein (fluid resuscitation) as an emergency treatment for African children suffering with shock from severe infections does not save lives, according to a major clinical trial funded ...

Ringer's acetate better for patients with severe sepsis

June 28, 2012
(HealthDay) -- Fluid resuscitation with hydroxyethyl starch (HES) 130/0.4 for patients with severe sepsis leads to an increased risk of death at day 90 and an increased likelihood of requiring renal-replacement therapy, compared ...

Intravenous fluid used for critically ill patients linked with adverse outcomes

February 19, 2013
In an analysis of studies that examined critically ill patients requiring an increase in blood fluid volume, intravenous use of the fluid hydroxyethyl starch, compared with other resuscitation solutions, was not associated ...

Clinical trial examines benefits of, mechanisms behind ultrafiltration for heart failure

February 23, 2012
University of Cincinnati cardiologists are conducting a one-of-a-kind clinical trial to determine if a dialysis-like procedure could be deemed the new standard of care for patients suffering from extensive fluid retention ...

Common IV fluid associated with reduced likelihood of full recovery in patients with cardiac arrest

February 19, 2013
Although an intravenous fluid that paramedics in Japan often give to patients in cardiac arrest before they reach hospital may help restore circulation, it may also be linked to reduced survival with minimal neurological ...

Recommended for you

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

Team eradicates hepatitis C in 10 patients following lifesaving transplants from infected donors

April 30, 2017
Ten patients at Penn Medicine have been cured of the Hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease. The findings point to new strategies for increasing ...

'bench to bedside to bench': Scientists call for closer basic-clinical collaborations

March 24, 2017
In the era of genome sequencing, it's time to update the old "bench-to-bedside" shorthand for how basic research discoveries inform clinical practice, researchers from The Jackson Laboratory (JAX), National Human Genome Research ...

The ethics of tracking athletes' biometric data

January 18, 2017
(Medical Xpress)—Whether it is a FitBit or a heart rate monitor, biometric technologies have become household devices. Professional sports leagues use some of the most technologically advanced biodata tracking systems to ...

Financial ties between researchers and drug industry linked to positive trial results

January 18, 2017
Financial ties between researchers and companies that make the drugs they are studying are independently associated with positive trial results, suggesting bias in the evidence base, concludes a study published by The BMJ ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.