In a large group of critically ill African children, fluid boluses significantly increased 48-hour mortality. The results were most marked in those with haemoglobin levels less than 5 g/dL. The results do not support the routine use of bolus resuscitation in severely ill febrile children with impaired perfusion in African hospitals.
Level of evidence: 1B: individual randomised control trial with narrow confidence intervals.
References
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MaitlandKAkechSORussellEC. Mortality after fluid bolus in African children with sepsis (Correspondence). N Engl J Med2011;365: 1351–53.