83 FEAST

Jane Crawley 12/11/18

Where was FEAST performed? : Uganda, Tanzani, Kenya (Typical hospitals in East Africa)

How many kids in feast? : 3600 (age 2m -> 12y)

What were the classification of sick kids in FEAST: Fever, One of Impaired Conscoiusness + Resp Distress. Plus circulatory impairment.

What were the signs of CV impairment in FEAST? : Fast HR Weak Pulse, Cold, Prolonged CRT

What fluid options were examined in FEAST? : Bolus = 20ml/kg (Albumin or Saline). No bolus

What kids were excluded from FEAST?: Gastroenteritis, Trauma, Burns, Malnutrition, Chronic Renal Failure

Severe Hypotension were excluded. Only 29 out of 3000 kids

What kind of diseases did kids with FEAST prevent with?: Anaemia, Malaria, Sepsis, Pneumonia

What was the primary outcome Measure in FEAST: Mortality at 48 hours

What was the secondary outcome measure in FEAST: Mortality 4 Weeks, Fluid Specific Adverse Outcomes

What are the four R’s to look for Clinical Trial Excellence? : Randomisation, Recruitment, Adhe r ence, Retention

What were the mortality outcomes seen in FEAST? : 3% difference. Worse in boluses (10% vs 7%). Boluses increase risk in every subgroup!

Why did kids die of fluid boluses in FEAST? : Majority didn’t die of fluid overload. They seem to die of “cardiovascular collapse”

Were the kids in FEAST sick: 1/2 had malaria, 1/3 had anaemia less than 5, 1/2 were acidotic

Were the kids in FEAST shocked?: Well looser definition than the WHO definition. But same mortality rate seen as other definitions of shock. And if you used the WHO definition of shock, boluses still die more

Does malaria explain the results of FEAST? : No. 1/2 had malaria. But both malaria and no malaria had same outcomes

Does anaemia explain the results of FEAST? : No. Well 1/3 of patients with FEAST had anaemia < 5. But all Hb levels had similar results in mortality.