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Increased deaths of children in shock, related to fluid resuscitation, are caused by cardiovascular collapse

15 March 2013

In 2011 FEAST trial showed that fluid resuscitation actually increased deaths in children in Africa with shock, it surprised many people, as fluid resuscitation is a standard practice in rich countries. Since then researchers have been looking in depth at the data from the trial, to try and understand why it increased deaths. The results of this work have now been published in BMC Medicine.

The FEAST trial was conducted in six African hospitals across Kenya, Tanzania and Uganda without intensive care facilities. It included 3000 children with shock caused by conditions including sepsis and malaria but excluded children with gastroenteritis, burns, surgical conditions or had severe malnutrition. All the children in the trial received standard treatments, depending on their illness, but were randomly assigned to receiving fluid resuscitation or to a control group without fluid resuscitation.

The researchers found that patients who received fluid resuscitation were more likely to no longer be in shock after one hour than those who had maintenance fluid alone. However, this did not translate into improved survival. In fact, children who received fluid resuscitation were more likely to die within 48 hours than those who did not. This increase was the same in all children who received fluid resuscitation, regardless of the severity of their illness or the symptoms they came to hospital with.

Many people thought that the increase in deaths were due to fluid overload leading to complications in the lungs or brain. However, the analysis found that it was actually lethal shock caused by cardiovascular collapse that was the main cause of death of children who died after receiving fluid resuscitation. These surprising findings highlight the need for more research to better understand shock and how to treat it.

This film looks in depth at the FEAST trial, and the importance of clinical trials to test treatments.