Mortality after fluid bolus in children with shock due to sepsis or severe infection: a systematic review and meta-analysis

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dc.contributor.authorFord, Nathanen_ZA
dc.contributor.authorHargreaves, Sallyen_ZA
dc.contributor.authorShanks, Leslieen_ZA
dc.date.accessioned2015-11-16T04:09:42Z
dc.date.available2015-11-16T04:09:42Z
dc.date.issued2012en_ZA
dc.description.abstractIntroduction Sepsis is one of the leading causes of childhood mortality, yet controversy surrounds the current treatment approach. We conducted a systematic review to assess the evidence base for fluid resuscitation in the treatment of children with shock due to sepsis or severe infection. METHODS: We searched 3 databases for randomized trials, quasi-randomized trials, and controlled before-after studies assessing children with septic shock in which at least one group was treated with bolus fluids. The primary outcome was mortality at 48 hours. Assessment of methodological quality followed the GRADE criteria. Relative risks (RRs) and 95% confidence intervals (CI) were calculated and data pooled using fixed-effects method. RESULTS: 13 studies met our inclusion criteria. No bolus has significantly better mortality outcomes at 48 hours for children with general septic shock (RR 0.69; 95%CI 0.54-0.89), and children with malaria (RR 0.64; 95%CI 0.45-0.91) when compared to giving any bolus. This result is largely driven by a single, high quality trial (the FEAST trial). There is no evidence investigating bolus vs no bolus in children with Dengue fever or severe malnutrition. Colloid and crystalloid boluses were found to have similar effects on mortality across all sub-groups (general septic shock, malaria, Dengue fever, and severe malnutrition). CONCLUSIONS: The majority of all randomized evidence to date comes from the FEAST trial, which found that fluid boluses were harmful compared to no bolus. Simple algorithms are needed to support health-care providers in the triage of patients to determine who could potentially be harmed by the provision of bolus fluids, and who will benefit.en_ZA
dc.identifier.apacitationFord, N., Hargreaves, S., & Shanks, L. (2012). Mortality after fluid bolus in children with shock due to sepsis or severe infection: a systematic review and meta-analysis. <i>PLoS One</i>, http://hdl.handle.net/11427/15007en_ZA
dc.identifier.chicagocitationFord, Nathan, Sally Hargreaves, and Leslie Shanks "Mortality after fluid bolus in children with shock due to sepsis or severe infection: a systematic review and meta-analysis." <i>PLoS One</i> (2012) http://hdl.handle.net/11427/15007en_ZA
dc.identifier.citationFord, N., Hargreaves, S., & Shanks, L. (2012). Mortality after fluid bolus in children with shock due to sepsis or severe infection: a systematic review and meta-analysis. PloS one, 7, e43953. doi:10.1371/journal.pone.0043953en_ZA
dc.identifier.ris TY - Journal Article AU - Ford, Nathan AU - Hargreaves, Sally AU - Shanks, Leslie AB - Introduction Sepsis is one of the leading causes of childhood mortality, yet controversy surrounds the current treatment approach. We conducted a systematic review to assess the evidence base for fluid resuscitation in the treatment of children with shock due to sepsis or severe infection. METHODS: We searched 3 databases for randomized trials, quasi-randomized trials, and controlled before-after studies assessing children with septic shock in which at least one group was treated with bolus fluids. The primary outcome was mortality at 48 hours. Assessment of methodological quality followed the GRADE criteria. Relative risks (RRs) and 95% confidence intervals (CI) were calculated and data pooled using fixed-effects method. RESULTS: 13 studies met our inclusion criteria. No bolus has significantly better mortality outcomes at 48 hours for children with general septic shock (RR 0.69; 95%CI 0.54-0.89), and children with malaria (RR 0.64; 95%CI 0.45-0.91) when compared to giving any bolus. This result is largely driven by a single, high quality trial (the FEAST trial). There is no evidence investigating bolus vs no bolus in children with Dengue fever or severe malnutrition. Colloid and crystalloid boluses were found to have similar effects on mortality across all sub-groups (general septic shock, malaria, Dengue fever, and severe malnutrition). CONCLUSIONS: The majority of all randomized evidence to date comes from the FEAST trial, which found that fluid boluses were harmful compared to no bolus. Simple algorithms are needed to support health-care providers in the triage of patients to determine who could potentially be harmed by the provision of bolus fluids, and who will benefit. DA - 2012 DB - OpenUCT DO - 10.1371/journal.pone.0043953 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Mortality after fluid bolus in children with shock due to sepsis or severe infection: a systematic review and meta-analysis TI - Mortality after fluid bolus in children with shock due to sepsis or severe infection: a systematic review and meta-analysis UR - http://hdl.handle.net/11427/15007 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15007
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0043953
dc.identifier.vancouvercitationFord N, Hargreaves S, Shanks L. Mortality after fluid bolus in children with shock due to sepsis or severe infection: a systematic review and meta-analysis. PLoS One. 2012; http://hdl.handle.net/11427/15007.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© Ford et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherSepsisen_ZA
dc.subject.otherChildrenen_ZA
dc.subject.otherMalariaen_ZA
dc.subject.otherMalnutritionen_ZA
dc.subject.otherSystematic reviewsen_ZA
dc.subject.otherColloidsen_ZA
dc.subject.otherDatabase searchingen_ZA
dc.subject.otherResuscitationen_ZA
dc.titleMortality after fluid bolus in children with shock due to sepsis or severe infection: a systematic review and meta-analysisen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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