Fluid choice for resuscitation in septic children

January 01, 0001

Fluid choice for resuscitation in septic children

These Kenyan and British researchers systemically reviewed the evidence from clinical trials comparing crystalloids and colloids in fluid resuscitation in children with severe infection. They used Medline, PubMed, the Cochrane Library, Embase, and reference lists, looking for studies examining fluid resuscitation with crystalloid or colloidal solutions in severe infectious illness in children under 12 years of age.

The researchers found: "Nine trials fulfilled criteria, eight of which compared crystalloids with colloids. All trials were conducted in settings with poor resources and predominantly included patients with malaria or dengue haemorrhagic shock. None of the trials had mortality as a primary outcome. Three out of six studies that reported at least one death showed better survival in children resuscitated with colloids compared with crystalloids (Peto fixed odds ratio ranging from 0.18 to 0.48). Studies contributing data on mortality had some methodological limitations so caution is recommended when interpreting this finding. Studies were heterogeneous so combined estimates were not calculated. The review was limited by inclusion of only published studies."

The researchers concluded: "The current evidence on choice of fluids for resuscitation in children with infections is weak. While existing trials have provided important evidence in malaria and dengue, resuscitation in children with paediatric sepsis, for which colloids could theoretically be of benefit, has not been studied. The evidence from existing studies is not robust enough to make any definitive recommendations over the choice of resuscitation fluid and a definitive trial is required to address this."

The data are largely lacking on whether crystalloids or colloids are a better fluid choice for children with sepsis, although colloids appear to be the fluid of choice with malaria or dengue.

For the full abstract, click here.

BMJ 341:c4416, 2 September 2010
© 2010 Akech et al.
Choice of fluids for resuscitation in children with severe infection and shock: systematic review. Samuel Akech, Hannah Ledermann, Kathryn Maitland,. Correspondence to K Maitland: kmaitland@kilifi.kemri-wellcome.org

Category: A. General/Unspecified. Keywords: fluid resuscitation, crystalloid, colloid, sepsis, children, systematic review, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 22 September 2010

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