Are we giving too much IV fluid?

The importance of prompt resuscitation with intravenous (IV) fluids in children with presumed sepsis or severe dehydration is well-known, and is emphasised in all resuscitation guidelines. But have we gone too far? The FEAST trial published in 2011 set alarm bells ringing (doi: 10.1056/NEJMoa1101549). In a sub-Saharan Africa setting, it showed that very ill, febrile children randomised to fluid boluses of either saline or albumin had a 3.3% higher mortality than those receiving only maintenance fluids. Those with gastro-enteritis were excluded. Since then questions have been asked about whether we might also be doing harm to less ill children in Western settings by overuse of fluids.

Two systematic reviews and meta-analyses have been published looking at different aspects of this dilemma. The first, by Canadian authors, looked for evidence linking fluid balance and outcomes in critically ill children on intensive care units (Alobaldi R et al doi: 10.1001/jamapediatrics.2017.4540). In these children,...

from Archives of Disease in Childhood current issue https://ift.tt/2Ha7mzf