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

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4416 (Published 02 September 2010) Cite this as: BMJ 2010;341:c4416
  1. Samuel Akech, clinical research fellow1,
  2. Hannah Ledermann, paediatric clinical trainee1,
  3. Kathryn Maitland, professor of tropical paediatric infectious disease12
  1. 1Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Programme, PO Box 230, Kilifi, Kenya
  2. 2Department of Paediatrics and Wellcome Trust Centre for Clinical Tropical Medicine, Faculty of Medicine, Imperial College, London W2 1PG
  1. Correspondence to: K Maitland, KEMRI Wellcome Trust Programme, PO Box 230, Kilifi, Kenya kmaitland{at}kilifi.kemri-wellcome.org
  • Accepted 28 June 2010

Abstract

Objective To systemically review the evidence from clinical trials comparing the use of crystalloids and colloids for fluid resuscitation in children with severe infection.

Data sources Medline (1950-2008), PubMed, the Cochrane Library, Embase (1980-2008), and reference lists.

Eligibility criteria Published studies comparing fluid resuscitation with crystalloid or colloidal solutions in severe infectious illness in children aged >1 month to ≤12 years. Controlled trials and randomised controlled trials were separately selected by two unblinded investigators who also independently extracted data.

Main outcome measures Efficacy in the treatment of shock, mortality, and reported adverse events.

Results 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 (95% confidence interval 0.02 to 1.42) to 0.48 (0.06 to 3.99)). 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.

Conclusions 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.

Footnotes

  • Contributors: SA and HL were responsible for the literature review and initial synthesis of results. SA was responsible for the data analysis. KM conceived the idea for the study and supervised literature review and results summaries. All authors contributed to the writing of the paper and approved the final draft. KM is guarantor.

  • Funding: This work was funded indirectly through programme support by the Wellcome Trust and Medical Research Council. SA is supported by a grant from the Wellcome Trust (No 084538). The Wellcome Trust had no role in the review and in the preparation of this manuscript.

  • Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any institution for the submitted work; no financial relationships with any institutions that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Not required.

  • Data sharing: No additional data available.

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