Clinical trial casts doubt on fluid treatment for shock

A clinical trial conducted in East Africa has challenged standard medical practice for treatment of shock.

The Fluid Expansion as Suppotive Therapy (FEAST) trial showed that children suffering from shock have an increased chance of fatal cardiovascular distress within 48 hours if they are treated with fluid.

A trial into the practice was conducted in six African hospitals across Kenya, Tanzania and Uganda. The facilities used did not have intensive care units.

Throughout the study, 3,000 children suffering shock as a result of conditions such as sepsis and malaria were assessed.

The research, which was led by Wellcome Trust Centre for Clinical Tropical Medicine, Imperial College London's Professor Kathryn Maitland, excluded children who had gastroenteritis, burns, severe malnutrition or who had recently undergone surgery.

In addition to the standard treatment to combat the underlying illness, some children received fluid resuscitation – known as boluses – for shock. A control group of youngsters were not given fluid resuscitation.

Professor Maitland commented: "The children who were given this treatment 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 cardiovascular collapse."

Following the trial, the research team suggested fluid resuscitation should not be used in environments where there is no access to intensive care facilities.

University of New South Wales's Professor John Myburgh added that fluid resuscitation should be used with caution, as it can have the same impact as potentially lethal drugs.

He added: "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."

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