Fluid Bolus in African Children with Severe Infection

FEAST · New England Journal of Medicine · 2011

A trial that contradicted standard teaching on fluid resuscitation and forced the question of how far its setting can be generalised.

Both bolus groups had higher 48-hour mortality than the no-bolus group.

The excess mortality was similar with albumin and with saline, so it was not a colloid-versus-crystalloid effect.

The excess appeared to be cardiovascular collapse rather than fluid overload or neurological deterioration.

Conducted where mechanical ventilation and intensive care support were largely unavailable — the most important limitation when applying it elsewhere.

Malaria and severe anaemia were common in the population.

Children with severe hypotension were a small subgroup, so the finding is weakest exactly where bolus is most reflexively given.

The result should not be read as "boluses are harmful everywhere" — the absence of ventilatory support is central to the mechanism proposed.

It does justify treating a fluid bolus as an intervention with risk rather than a default.