In the resuscitation of febrile children, albumin and saline boluses can lead to serious respiratory, neurological and haematological complications, according to a new research published in the Lancet Respiratory Medicine.
The study, led by Imperial College London, examined vital sign data from the Fluid Expansion as Supportive Therapy (FEAST) trial to develop composite scores for respiratory, cardiovascular and neurological function and used them to compare participants from FEAST with those from four other cohorts and to identify differences between the bolus (n=2097) and no bolus (n=1044) groups of FEAST. The odds of adverse outcome were calculated for each 10-unit increase in baseline score.
Increasing respiratory (odds ratio [OR], 1.09; 95% CI, 1.07-1.11), neurological (OR, 1.26; 95% CI, 1.21-1.31) and cardiovascular scores (OR, 1.09; 95% CI, 1.05-1.14) were associated with death in FEAST (all P<.001), and with adverse outcomes for specific scores in the four other cohorts.
In FEAST, fluid bolus increased respiratory and neurological scores and decreased cardiovascular score at one hour after commencement of the infusion.
Fluid bolus recipients also had mean 0.33 (95% CI, 0.20-0.46) g/dL reduction in haemoglobin concentration after eight hours (P<.0001).
A decrease of 1.41 (95% CI, 0.76-2.06) mEq/L (P=.0002) in mean base excess and increase of 1.65 (95% CI, 0.47-2.8) mmol/L (P=.0070) in mean chloride, and a decrease of 0.96 (95% CI, 0.45-1.47) mmol/L (P=.0003) in bicarbonate, were seen at 24 hours.
Hyperchloraemic acidosis and respiratory and neurological dysfunction induced by saline or albumin bolus explained the excess mortality due to bolus in Cox survival models.
The authors say the findings “support the notion that fluid resuscitation with unbuffered electrolyte solutions may cause harm and their use should be cautioned”. They advise that the effects of lower volumes of buffered solutions should be evaluated further.
