Related Experiment Video
Updated: Mar 29, 2026
Fixed Volume or Fixed Pressure: A Murine Model of Hemorrhagic Shock
Published on: June 6, 2011
Mortality and Other Outcomes in Relation to First Hour Fluid Resuscitation Rate: A Systematic Review
A Tripathi1, S K Kabra, H P S Sachdev
1Departments of Pediatrics; AIIMS, and *Sitaram Bhartia Institute of Science and Research; New Delhi, India. Correspondence to: Dr Rakesh Lodha, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India. rakesh_lodha@hotmail.com.
Insights
Fluid bolus administration in children with impaired circulation may increase mortality compared to maintenance fluids alone. Further research is needed to determine optimal fluid resuscitation rates in diverse settings.
Area of Science:
- Pediatric Critical Care Medicine
- Emergency Medicine
- Fluid Resuscitation Strategies
Background:
- Impaired circulation in children, particularly febrile illness, presents a significant mortality risk.
- Optimal fluid administration rates in the first hour remain a critical clinical question.
Purpose of the Study:
- To evaluate the impact of different first-hour fluid administration regimens on mortality and circulatory compromise in children aged 2-60 months with impaired circulation.
Main Methods:
- A systematic review of randomized controlled trials was conducted.
- Searches were performed across major databases including PubMed, Cochrane Library, and EMBASE.
- One trial (FEAST Trial) met inclusion criteria, comparing fluid boluses to maintenance fluids alone.
Main Results:
- The FEAST Trial indicated higher 48-hour mortality in children receiving fluid boluses compared to maintenance fluids alone (RR 1.45).
- For children meeting WHO criteria for shock, bolus administration was associated with increased mortality (RR 2.40), though evidence quality was very low.
- Moderate quality evidence suggests increased mortality with fluid boluses in this population.
Conclusions:
- Current evidence from a single trial in low-resource settings suggests fluid bolus administration may increase mortality in children with severe febrile illness and impaired perfusion.
- Findings may not be generalizable to all shock severities, causes, or healthcare settings.
- Urgent research is needed to establish optimal fluid resuscitation rates for pediatric impaired circulation in various contexts.
Objective:
To determine the effect of different regimen of first hour fluid administration rates on mortality and severe consequences of impaired circulation in 2 to 60 months old children with impaired circulation.
Design:
Systematic review of randomized controlled trials.
Data Sources:
Various databases including PubMed, Cochrane Library and EMBASE were searched.
Results:
We found only two relevant trials; one was excluded as there was no comparator arm. Only one study (The FEAST Trial) compared boluses with maintenance fluid alone in children with severe febrile illness and one or more signs of impaired perfusion. The 48 hour mortality was more in the bolus group (RR 1.45, 95% CI 1.13,1.86). The quality of evidence is rated as moderate. For the children who met the WHO criteria for shock (severely impaired circulation) (n=65 children), those receiving boluses had higher mortality (RR 2.40, 95% CI 0.84, 6.88); the quality of evidence was rated as very low.
Conclusion:
A single large randomized controlled trial conducted in low-resource settings indicates that administration of fluid bolus is associated with higher mortality in comparison to the maintenance fluids alone in children with severe febrile illness and one or more signs of impaired perfusion. The findings are not generalizable to contexts with different severity of and different causes of shock and in centers with better facilities. There is urgent need for research in different settings to determine the optimal rate of fluid resuscitation in the first hour in children presenting with impaired circulation, particularly with severely impaired circulation.
Related Concept Videos
01:21Cardiopulmonary Resuscitation I: Adult
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...