Choice of fluids for resuscitation in children with severe infection and shock: systematic review

Deepak Kumar Singh, Lekha Tuli.
Email id: deepakbhu@gmail.com, tuli_lekha@rediffmail.com

A very important finding from the study by Akech et al [1] can be
extrapolated. There is an absence of any preference or guidelines for
crystalloids or colloids in resuscitation of children in shock and severe
infection. Yet, children are treated and have been treated in the past.
One cannot deny that the availability of a given resuscitation fluid, cost
incurred, personal experience and preference of a clinician, are some
important aspects that have to be borne in mind. This is true as high
infection rates and increased demand of fluid resuscitation is more in the
developing countries which make the aforementioned parameters more vital
in the resuscitation and patient (children) management.

However, a proper study can help discern out the contrasting benefits
(if any) between the use of the crystalloids or the colloids. Crystalloids
have more widespread use, irrespective of the capillary permeability which
if present can cause fluid retention on using colloids. Whereas, albumin
solution have an added advantage for children as they have higher
nutrition requirements and lesser chances of survival unlike adults.
However, to conclude we can say that personal experience with the use of
fluids will reign for many years to come until someone dares to perform a
randomized trial in children! All the more, use of fluids alone (either
crystalloids or colloids) is so promising [1] that use of one may fail to
bring an outstanding result when compared to other.

References:

1. Choice of fluids for resuscitation in children with severe
infection and shock: systematic review , Akech S, Ledermann H, Maitland K,
BMJ 341:doi:10.1136/bmj.c4416