Fluid Bolus

[turkeyjerky]

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How, if at all, has the FEAST Trial affected your fluid management strategy?

 

[eviorr]

It has certainly made me more judicious in using large volume fluid resuscitation in all of my pediatric patients with septic shock in sub-Saharan Africa. We should always be cautious in extrapolating results from a study to populations other than that which was studied. In particular, the causative agents of septic shock are likely to be significantly different between sub-Saharan Africa and Washington, DC, where I practice. Also, the baseline health of the patients prior to illness is likely quite different. 92.7% survival versus 89.4% is small enough (even if it is statistically significant) that I wouldn't feel comfortable generalizing the results to my patient population.

- Erick

 

[jcu]

It has certainly made me more judicious in using large volume fluid resuscitation in all of my pediatric patients with septic shock in sub-Saharan Africa.

 

[BigRedBeta]

Not a single iota.

While the headline got my attention initially, after I had looked through the study, I realized that it was not relevant to my practice as a pediatrician at a hospital that has a high volume, well staffed, high acuity PICU. Really, anywhere in the US this study has no relevance.

 

[deleted109597]

The only group I would possibly change management of here in the States is the septic sickler/cancer/anemic patient. Otherwise no extrapolation.

 

[michigangirl]

How, if at all, has the FEAST Trial affected your fluid management strategy?

As others have stated, this study is not generalizable to the population most of us take care of-- there might be great internal validity, but external validity is just not there. This is classic epidemiology in action. The only way to decide whether a study is generalizable is to use your existing knowledge base of the subject at hand. The group studied and our groups are not exchangeable.

 

[SurfingDoctor]

The take home of that study was if you are sick from malaria, fluid doesn't help your mortality (but Mefloquine might)