Randomised trial of fluid resuscitation strategies in African children with severe febrile illness & impaired perfusion

在整个撒哈拉以南非洲的医院中，儿童严重感染的病死率仍为15- 30%。在该地区，每年有100多万儿童死于严重感染。目前，抗疟和抗微生物药物是治疗的主要手段，但由于严重疾病的并发症，大多数死亡发生在早期，而且在确定的治疗措施有时间采取行动之前。在这种情况下，医生不得不依靠支持疗法来治疗并发症并试图改善结果。由于缺乏针对这一问题的临床试验，确定哪种是最好的挽救生命的治疗方法一直受到挫折。通过快速输注（容量扩张）纠正液体不足是急诊就诊的患病儿童的常规做法，对于患有严重疾病和灌注受损迹象的非洲儿童来说，这将是一种合理的支持性治疗。目前，采用这种方法的沉默仍然存在，因此大多数儿童在很少或没有额外液体的情况下进行管理。FEAST是一项多中心研究，旨在解决这一问题，并明确确定使用生理盐水或白蛋白进行扩容是否能改善无残疾生存率，以及最佳实现方式是使用生理盐水（一种广泛使用的廉价溶液）还是使用更昂贵的胶体白蛋白（一种安全的输血副产品）。如果能证明其益处，每年可能挽救数千名幼儿的生命。初步分析表明，这是一种提高儿童生存率的高成本效益方法，可以很容易地在未来的国际指南中采用，用于治疗患有严重疾病和灌注受损迹象的儿童。

In hospitals throughout sub-Saharan Africa case fatality rates for severe infections in childhood remains at 15-30%. In this region well over a million children die of severe infection in hospital each year. Currently, antimalarial and antimicrobial drugs are the mainstay of treatment, however most deaths occur early, due to the complications of severe illness, and before definitive treatments have time to act. In this situation doctors have to rely upon supportive therapies to treat complications and try to improve outcome. Defining which are the best life saving treatments has been frustrated by the lack of clinical trials addressing this issue. Correction of fluid deficits by rapid infusion (volume expansion) is practised routinely for sick children presenting for emergency care and would be a logical supportive treatment for African children with severe illness and signs of impaired perfusion. Currently, reticence to adopt this approach remains and so most children are managed with little or no additional fluid. In these circumstances the method resolving uncertainty is though in a clinical trial.FEAST is a multi centre study which aims to address this question and to definitively establish whether volume expansion with saline or albumin improves disability-free survival and whether this is best achieved by saline, a cheap a widely used solution or the more expensive colloid, albumin (a safe bi-product of a blood transfusion). If benefit were shown it could potentially save thousands of lives of young children annually. Preliminary analysis suggest that this represents a highly cost effective method for improving child survival and which could be easily adopted within future international guidelines for treating children with severe illness and signs of impaired perfusion.