Mortality after fluid bolus in African children with severe infection

Authors: Kathryn Maitland, Sarah Kiguli, Robert O. Opoka, Charles Engoru, Peter Olupot-Olupot, Samuel O. Akech, Richard Nyeko, George Mtove, Hugh Reyburn, Trudie Lang, Bernadette Brent, Jennifer A. Evans, James K. Tibenderana, Jane Crawley, Elizabeth C. Russell, Michael Levin, Abdel G. Babiker, Diana M. Gibb

Abstract

The role of fluid resuscitation in the treatment of children with shock and life threatening infections who live in resource-limited settings is not established. Thus, the study randomly assigned children with severe febrile illness and impaired perfusion to receive boluses of 20 to 40 ml of 5% albumin solution (albumin-bolus group) or 0.9% saline solution (saline-bolus group) per kilogram of body weight or no bolus (control group) at the time of admission to a hospital in Uganda, Kenya, or Tanzania (stratum A), as well as children with severe hypotension were randomly assigned to one of the bolus groups only (stratum B). All children received appropriate antimicrobial treatment, intravenous maintenance fluids, and supportive care, according to guidelines; however children with malnutrition or gastroenteritis were excluded from the data analysis.

Citation: New England Journal of Medicine, 2011; 364: 26.