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Open Access Commentary

Causes of death after fluid bolus resuscitation: new insights from FEAST

John Myburgh1* and Simon Finfer2

Author Affiliations

1 St George Clinical School, University of New South Wales, The George Institute for Global Health, L13, 321 Kent Street, Sydney 2000, Australia

2 Royal North Shore Hospital, University of Sydney, The George Institute for Global Health, L13, 321 Kent Street, Sydney 2000, Australia

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BMC Medicine 2013, 11:67  doi:10.1186/1741-7015-11-67


Please see related research article here http://www.biomedcentral.com/1741-7015/11/68

Published: 14 March 2013

Abstract

The Fluid Expansion as Supportive Therapy (FEAST study) was an extremely well conducted study that gave unexpected results. The investigators had reported 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. In a secondary analysis of the trial, published in BMC Medicine, the authors found that increased mortality was evident in patients who presented with clinical features of severe shock in isolation or in conjunction with features of respiratory or neurological failure. The cause of excess deaths was primarily refractory shock and not fluid overload. These features are consistent with a potential cardiotoxic or ischemia-reperfusion injury following resuscitation with boluses of intravenous fluid. Although these effects may have been amplified by the absence of invasive monitoring, mechanical ventilation or vasopressors, the results provide compelling insights into the effects of intravenous fluid resuscitation and potential adverse effects that extend beyond the initial resuscitation period. These data add to the increasing body of literature about the safety and efficacy of intravenous resuscitation fluids, which may be applicable to management of other populations of critically ill patients.

Keywords:
albumin; cardiogenic shock; FEAST trial; fluid resuscitation; malaria; pediatrics; reperfusion injury; saline; sepsis; shock