Following the recent online discussion around the FiSH pilot study and the potential harms of fluid boluses demonstrated in the FEAST trial it would seem apropos to release this talk from DFTB18. We seem to have a knee jerk reaction to give a fluid bolus in septic children but should we?
The FEAST trial was published in 2011 and has had very little impact on what we do in the Western setting. What we think of as a low fluid state – dehydration – is not the same as what our colleagues in Africa would view as sepstic. This is something we will explore at a later date. So if we can’t rely wholly on our history and our physical exam is often equivocal then what other methods are there?