CHOICE OF FLUIDS FOR RESUSCITATION IN

CHILDREN WITH SEVERE INFECTION AND

SHOCK: SYSTEMATIC REVIEW
ABSTRACT
Objective
To systemically review the evidence from clinical trials comparing the
use of crystalloids and colloids for fluid resuscitation in children with
severe infection.

Data sources
Medline (1950-2008), PubMed, the Cochrane Library, Embase
(1980-2008), and reference lists.

Main outcome measures

Efficacy in the treatment of shock, mortality, and reported adverse
events.
METHODS
Eligibility criteria
1. Controlled trials, quasi-randomised trials, cohort studies,
and randomised controlled
2. The treatment of shock in children aged between 1 month
and 12 years
3. Crystalloids versus colloids, crystalloids versus
crystalloids, or colloids versus colloids.
RESULTS

 4 studies were in children with malaria

 4 in those with dengue shock syndrome
 1 study in those with sepsis
RESULTS

Treatment of shock
1. Dengue Shock
Vietnam (resolution of shock)
Severe shock,  Colloids >> Ringers lactate.
Moderate shock  Ringers lactate = colloids
Philippines (controlled shock)
Hydroxyethyl starch 6% (HES 6%) >> Ringers lactate
RESULTS
2. Sepsis (resolution of shock)
 Saline = gelatin polymer (Haemaccel).
3. Severe malaria
 A significant overall reduction in
mortality in the albumin group.
RESULTS
Adverse Events
1. Dengue
8 % children who received Dextran, developed signs
of severe reactions, which included fever and rigors
9% children who received Gelafundin developed
allergic reactions
2. Sepsis
No adverse reactions
3. Severe Malaria
Non-significant increase in neurological sequelae
with human albumin solutioN.
DISCUSSION

Summary of evidence
1. Fluid resuscitation is common in modern paediatrics,
with recommendations based on consensus or expert
opinion
2. As the studies were not designed with mortality as the
primary outcome and used different definitions of
resolution of shock as outcomes, it would be
methodologically incorrect and misleading
CONCLUSION
This review did not identify sufficient evidence to inform the
preferential use of either colloids or crystalloids for treating
paediatric shock.
ALGORITHM FOR FLUID MANAGEMENT OF DENGUE SHOCK
(WHO 2012)
SURVIVING SEPSIS CAMPAIGN
(GUIDELINE 2012)