Trial reportCritical care (London, England)2018
Implications for paediatric shock management in resource-limited settings: a perspective from the FEAST trial.
Trial report in Critical care (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.
- Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children.Intensive care medicine · 2020Guideline
- Early inotropic support without fluid bolusWorld journal of clinical pediatrics · 2026Article
- Fluid Resuscitation in Pediatric Cerebral Malaria: Insights from the FEAST Trial and Further Evidence from Malawi.The American journal of tropical medicine and hygiene · 2025Article
- Comprehensive assessment of pediatric acute and inpatient care at a tertiary referral hospital in Malawi: opportunities for quality improvement.BMJ paediatrics open · 2024Article
- Prevalence, mortality, and aetiology of paediatric shock in a tertiary hospital in Malawi: A cohort study.PLOS global public health · 2024Article
- State-of-the-art management of the acutely unwell child.Anaesthesia · 2022Review
- Medication and Fluid Management of Pediatric Sepsis and Septic Shock.Paediatric drugs · 2022Review
- Challenges and Solutions in translating sepsis guidelines into practice in resource-limited settings.Translational pediatrics · 2021Review
- Paediatrics: how to manage septic shock.Drugs in context · 2021Review
- Multidrug resistant and extensively drug resistant Acinetobacter baumannii hospital infection associated with high mortality: a retrospective study in the pediatric intensive care unit.BMC infectious diseases · 2020Article
- Microvascular Fluid Exchange: Implications of the Revised Starling Model for Resuscitation of Dengue Shock Syndrome.Frontiers in medicine · 2020Review
- Mortality risk over time after early fluid resuscitation in African children.Critical care (London, England) · 2019Article
- Effects of saline or albumin fluid bolus in resuscitation: evidence from re-analysis of the FEAST trial.The Lancet. Respiratory medicine · 2019Article
- Emergency fluid bolus therapy studies: first do no harm.Archives of disease in childhood · 2019Article
- Refractory Shock in Pediatric Emergency Departments: Challenges and Innovations in Early Escalation: A Narrative Review.Sage open pediatricsReview
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundAlthough the African "Fluid Expansion as Supportive therapy" (FEAST) trial showed fluid resuscitation was harmful in children with severe febrile illness managed in resource-limited hospitals, the most recent evidence reviewed World Health Organization (WHO) guidelines continue to recommend fluid boluses in children with shock according to WHO criteria "WHO shock", arguing that the numbers included in the FEAST trial were too small to provide reasonable certainty.
methodsWe re-analysed the FEAST trial results for all international definitions for paediatric shock including hypotensive (or decompensated shock) and the WHO criteria. In addition, we examined the clinical relevance of the WHO criteria to published and unpublished observational studies reporting shock in resource-limited settings.
resultsWe established that hypotension was rare in children with severe febrile illness complicating only 29/3170 trial participants (0.9%). We confirmed that fluid boluses were harmful irrespective of the definitions of shock including the very small number with WHO shock (n = 65). In this subgroup 48% of bolus recipients died at 48 h compared to 20% of the non-bolus control group, an increased absolute risk of 28%, but translating to an increased relative risk of 240% (p = 0.07 (two-sided Fisher's exact test)). Examining studies describing the prevalence of the stringent WHO shock criteria in children presenting to hospital we found this was rare (~ 0.1%) and in these children mortality was very high (41.5-100%).
conclusionsThe updated WHO guidelines continue to recommend boluses for a very limited number of children presenting at hospital with the strict definition of WHO shock. Nevertheless, the 3% increased mortality from boluses seen across FEAST trial participants would also include this subgroup of children receiving boluses. Recommendations aiming to differentiate WHO shock from other definitions will invariably lead to "slippage" at the bedside, with the potential of exposing a wider group of children to the harm of fluid-bolus therapy.
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