Imperial College London
Alternate

ProfessorKathMaitland

Faculty of Medicine, Department of Surgery & Cancer

Professor of Tropical Paediatric Infectious Disease
 
 
 
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Contact

 

k.maitland CV

 
 
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Location

 

Based full-time at KEMRI/Wellcome Programme, KenyaQueen Elizabeth and Queen Mary HospitalSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{George:2019:10.1186/s13054-019-2619-y,
author = {George, EC and Kiguli, S and Olupot, PO and Opoka, RO and Engoru, C and Akech, SO and Nyeko, R and Mtove, G and Mpoya, A and Thomason, MJ and Crawley, J and Evans, JA and Gibb, DM and Babiker, AG and Maitland, K and Walker, AS},
doi = {10.1186/s13054-019-2619-y},
journal = {Critical Care (UK)},
pages = {1--9},
title = {Mortality risk over time after early fluid resuscitation in African children},
url = {http://dx.doi.org/10.1186/s13054-019-2619-y},
volume = {23},
year = {2019}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundAfrican children hospitalised with severe febrile illness have a high risk of mortality. The Fluid Expansion As Supportive Therapy (FEAST) trial (ISCRTN 69856593) demonstrated increased mortality risk associated with fluid boluses, but the temporal relationship to bolus therapy and underlying mechanism remains unclear.MethodsIn a post hoc retrospective analysis, flexible parametric models were used to compare change in mortality risk post-randomisation in children allocated to bolus therapy with 20–40 ml/kg 5% albumin or 0.9% saline over 1–2 h or no bolus (control, 4 ml/kg/hour maintenance), overall and for different terminal clinical events (cardiogenic, neurological, respiratory, or unknown/other).ResultsTwo thousand ninety-seven and 1041 children were randomised to bolus vs no bolus, of whom 254 (12%) and 91 (9%) respectively died within 28 days. Median (IQR) bolus fluid in the bolus groups received by 4 h was 20 (20, 40) ml/kg and was the same at 8 h; total fluids received in bolus groups at 4 h and 8 h were 38 (28, 43) ml/kg and 40 (30, 50) ml/kg, respectively. Total fluid volumes received in the control group by 4 h and 8 h were median (IQR) 10 (6, 15) ml/kg and 10 (10, 26) ml/kg, respectively. Mortality risk was greatest 30 min post-randomisation in both groups, declining sharply to 4 h and then more slowly to 28 days. Maximum mortality risk was similar in bolus and no bolus groups; however, the risk declined more slowly in the bolus group, with significantly higher mortality risk compared to the no bolus group from 1.6 to 101 h (4 days) post-randomisation. The delay in decline in mortality risk in the bolus groups was most pronounced for cardiogenic modes of death.ConclusionsThe increased risk from bolus therapy was not due to a mechanism occurring immediately after bolus administration. Excess mortality risk in the bolus group resul
AU  - George,EC
AU  - Kiguli,S
AU  - Olupot,PO
AU  - Opoka,RO
AU  - Engoru,C
AU  - Akech,SO
AU  - Nyeko,R
AU  - Mtove,G
AU  - Mpoya,A
AU  - Thomason,MJ
AU  - Crawley,J
AU  - Evans,JA
AU  - Gibb,DM
AU  - Babiker,AG
AU  - Maitland,K
AU  - Walker,AS
DO  - 10.1186/s13054-019-2619-y
EP  - 9
PY  - 2019///
SN  - 1364-8535
SP  - 1
TI  - Mortality risk over time after early fluid resuscitation in African children
T2  - Critical Care (UK)
UR  - http://dx.doi.org/10.1186/s13054-019-2619-y
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000501779700004&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2619-y
UR  - http://hdl.handle.net/10044/1/80623
VL  - 23
ER  -
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