Choice of fluids for resuscitation in children with severe infection and shock: systematic review.
OBJECTIVE
To systemically review the evidence from clinical trials comparing the use of crystalloids and colloids for fluid resuscitation in children with severe infection.


METHODS
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 <or=12 years. Controlled trials and randomised controlled trials were separately selected by two unblinded investigators who also independently extracted data.


METHODS
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.
Akech
Samuel
S
Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Programme, PO Box 230, Kilifi, Kenya.
Ledermann
Hannah
H
Maitland
Kathryn
K
D000418:Albumins / Q000627:therapeutic use; D015982:Bias; D002648:Child; D002675:Child, Preschool; D003102:Colloids / Q000627:therapeutic use*; D018849:Controlled Clinical Trials as Topic; D000077324:Crystalloid Solutions; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007223:Infant; D007239:Infections / Q000150:complications*; D007552:Isotonic Solutions / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012151:Resuscitation / Q000379:methods*; D012769:Shock / Q000628:therapy*
D000418:Albumins; D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions
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