First EMTC Weekly Article

Mortality after fluid bolus in African children with severe infection. N Engl J Med. 2011 Jun 30;364(26):2483-95.

Originally sent by Rasha

Dear All,

The EMTC Weekly article has begun. Enjoy!

In the spirit of the Global PEM group, I couldn't resist but to pick this article. (Thank you Jen) While working in the Ivory Coast last fall, I was struck by the lack of IVF use. I could understand the fear for severely anemic or malnourished patients, but why the knee jerk for everyone else?

So I kept insisting on the use of fluid boluses for resuscitation. Yet the national staff was reticent. I wondered why? is it their lack of knowledge? Their experience that I didn't understand? Was their evidence in the literature that I was not aware of? Why would the treatment of septic shock be different between little west african children and the US ones?

This article, a multi-centered randomized control, prospective study shows that fluid boluses compared to no bolus, in children with septic shock, in resource poor settings increases their mortality! Now THAT is  shocker!!! Comments have been made that maybe the severely anemic children biased the results (see figure 3) or for example the lack of an ICU setting to deal with pulmonary edema affected the results. But the authors replied to these comments. (see attached letters).

Now, will this article change my way of practice when I return to west Africa? Will it change it in the CNMC PED?  I'm a good old human and old habits (Fluid/fluid/fluid) die hard!
But it definitely puts it all in perspective. And I will definitely be less aggressive with my fluid boluses next time I'm in a  low resource setting.