Fluids in Pediatric Sepsis

Abstract

Abstract The current standard of care for treating hypovolemic shock and impaired circulation are fluid boluses. The Fluid Expansion as Supportive Therapy (FEAST) trial investigates the practice of early resuscitation with a saline bolus as compared with no bolus (control) and with an albumin bolus as compared with a saline bolus. They found that in children with febrile illness without severe hypotension, bolus resuscitation increased absolute risk of death at 48 hours by 3.3%. The results of the FEAST trial would seem to suggest that fluids should be given cautiously in children with early signs of sepsis, but should be interpreted with caution due to the limitations of the study. As a result of the FEAST trial, the WHO suggests cautious fluid administration in children with malnourishment, anemia, or malaria, and the 2012 Surviving Sepsis campaign restricts fluid resuscitation in pediatric patients to industrialized nations. Additionally, the FEAST trial is prompting investigation into how fluids are given to children in higher-resourced settings.