While all commodities move in cycles, sugar in India is a case study in feast-to-famine swings in which bountiful crops are followed by anemic harvests every two or three years.
FEAST study in 2011 [68] also showed no benefit of albumin over crystalloids.
The most compelling data that fluid loading in sepsis is harmful come from The Fluid Expansion as Supportive Therapy (FEAST) study performed in 3,141 sub-Saharan children with severe sepsis [60].
In the FEAST study, despite specific comorbid conditions compared to those seen in industrialized countries, the increased mortality of children receiving fluid boluses was found to be due to cardiac events (cardiogenic shock) related to fluid overload [24].
FEAST study in 2011 [ 68] also showed no benefit of albumin over crystalloids.
Quote from a mother of a child enrolled in the Fluid Expansion as Supportive Therapy (FEAST) study [ 50 ].
A proportion of children (23 in Kilifi, 100 in Mbale) were recruited as part of the FEAST study (Fluid Expansion as a Supportive Therapy) [ 21].
By contrast, in the recent FEAST study of fluid management in children presenting with severe sepsis in Kenya, Tanzania and Uganda, rapid fluid bolus volume expansion was associated with significant harm [ 67]; importantly, however, fluid therapy in the FEAST study was not guided by any form of invasive haemodynamic monitoring.
CR-sera from rats and monkeys as well as from human participants in the FEAST study have all consistently induced increased levels of SIRT1 in various cell types exposed to these sera for short time periods [ 38, 53].
Now that the FEAST study has created such a challenge [ 6], it seems important to reflect on why we believe fluid bolus resuscitation should be a cornerstone of the management of severe sepsis or septic shock.
Given the findings and limitations of the FEAST study, however, and the context discussed above, it remains legitimate to ask: what is the role of fluid bolus resuscitation in human sepsis?
