Mortality after fluid bolus in African children with severe infection.

Maitland K, Kiguli S, Opoka RO, et al.

N Engl J Med 2011;364(26):2483-2495.

NATA Rating :
Review by : P. Van der Linden
NATA Review

Performed in resource-limited settings in Africa, this multicenter open randomized controlled study assessed the effects of fluid bolus resuscitation with either 0.9% saline or 5% albumin in non-hypotensive children admitted with febrile medical illness. Fluid boluses (20 ml/kg) with either solution significantly increased 48-hour and 4-week mortality compared to no bolus, although the incidence of pulmonary edema or increased intracranial pressure were not different between groups.

Although these results cannot be extrapolated to children with significant hypotension related to conditions such as severe dehydration from gastroenteritis, malnutrition, burns and surgery, they may have important impact even for clinicians working in high-income countries. Indeed, as highlighted in the accompanying editorial by Myburgh, they indicate that bolus-fluid resuscitation with either crystalloids or albumin in critically ill septic children with no evident clinical fluid deficit should be performed with greater caution than is usually the case.

– Philippe Van der Linden

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