{"id":619,"date":"2016-08-22T15:21:35","date_gmt":"2016-08-22T15:21:35","guid":{"rendered":"https:\/\/imperialighi.wordpress.com\/?p=619"},"modified":"2019-03-29T10:52:03","modified_gmt":"2019-03-29T10:52:03","slug":"feast-five-years-on","status":"publish","type":"post","link":"https:\/\/blogs-staging.imperial.ac.uk\/ighi\/2016\/08\/22\/feast-five-years-on\/","title":{"rendered":"FEAST \u2013 five years on"},"content":{"rendered":"

By Professor Kathryn Maitland<\/a>, Director of the IGHI Centre of\u00a0African Research and Engagement<\/a>.\u00a0<\/em><\/p>\n

First published by the Hippocratic Post<\/a> on 22\/8\/16.<\/p>\n

\"kath
Professor Kathryn Maitland<\/figcaption><\/figure>\n

\u2018Back in 2011, my research team published the results of the largest trial\u00a0of critically ill children ever undertaken in Africa (FEAST\u00a0trial), a trial that examined fluid resuscitation\u00a0strategies in children with severe febrile illnesses (including malaria\u00a0and bacterial sepsis). Contrary to expectation, the trial showed that\u00a0fluid boluses were associated with an increased mortality compared to\u00a0no-bolus (control), the greatest effect was in children with the most\u00a0severe forms of shock. We were delighted when the FEAST trial won the\u00a0prestigious 2011 BMJ Research Paper of the Year award and expected that\u00a0doctors around the world would sit up and take notice \u2013 and guidelines for\u00a0management of children suffering from shock due to sepsis would change.<\/p>\n

However, five years on, I have to say that I am disappointed that the WHO\u00a0guidelines in resource-poor settings are still largely unaltered.\u00a0Although the humanitarian aid charity Medicins sans Frontieres changed its\u00a0own procedures within nine months of our results becoming public, the\u00a0directing and coordinating agency for international health of the United\u00a0Nations has so far left existing guidelines in place. This is despite the\u00a0fact that we found that the intervention of rapidly administering fluids\u00a0was actually harmful to children in our study which was robust and based\u00a0on sound scientific evidence. One statistician said it was the most\u00a0consistent he had ever seen.<\/p>\n

What we found was the administering fluids did have an immediate effect of\u00a0brining children round so they appeared to be better in the short term,\u00a0but four or five hours later many of the children suffered a catastrophic\u00a0vascular collapse, which often sent them into deeper shock. In low GDP\u00a0countries, where there are few intensive care facilities to support\u00a0children in this emergency, this deep shock can lead to death in many\u00a0cases. Interestingly, this result may be masked in developed countries\u00a0where children have better support after they are brought into hospital\u00a0and can\u00a0 be given special drugs called inotropes to assist the recovery of\u00a0the circulatory system. However, no research has been done to confirm or\u00a0refute this.<\/p>\n

The WHO guidelines committee looked at the evidence and decided to\u00a0downplay our results. One of the problems was that the members of the\u00a0committee themselves did not have sufficient expertise to review the\u00a0evidence we presented and understand the context. I did write a very\u00a0detailed response to their conclusion, but it was ignored.<\/p>\n

So they retained the guideline to give very sick children a rapid infusion\u00a0of fluids, but tempered it with the recommendation that children would\u00a0also be given inotropes. But this just shows the lack of understanding of\u00a0the committee of what actually happens in resource poor settings. Access\u00a0to drugs can be limited and the logistics may not be in place to get them\u00a0to where they are needed. Inotropes cannot just be popped under the tongue\u00a0by a healthcare assistant. They need to given as a continuous infusion by\u00a0a trained professional who may well not exist.<\/p>\n

In my opinion, this lack of decisive action is costing tens of thousands\u00a0of children their lives in Africa. It is very frustrating for people like\u00a0me who are working in areas where it is having a dramatic negative impact.\u00a0It is like trying to change the direction of a juggernaut which thunders\u00a0on despite all the evidence that it is going the wrong way.<\/p>\n

\"children-730x430\"<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

By Professor Kathryn Maitland, Director of the IGHI Centre of\u00a0African Research and Engagement.\u00a0 First published by the Hippocratic Post on 22\/8\/16. \u2018Back in 2011, my research team published the results of the largest trial\u00a0of critically ill children ever undertaken in Africa (FEAST\u00a0trial), a trial that examined fluid resuscitation\u00a0strategies in children with severe febrile illnesses (including […]<\/p>\n","protected":false},"author":1060,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14884,301308,301172],"tags":[],"class_list":["post-619","post","type-post","status-publish","format-standard","hentry","category-africa","category-diseases","category-maternal-and-child-health"],"_links":{"self":[{"href":"https:\/\/blogs-staging.imperial.ac.uk\/ighi\/wp-json\/wp\/v2\/posts\/619","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs-staging.imperial.ac.uk\/ighi\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs-staging.imperial.ac.uk\/ighi\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs-staging.imperial.ac.uk\/ighi\/wp-json\/wp\/v2\/users\/1060"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs-staging.imperial.ac.uk\/ighi\/wp-json\/wp\/v2\/comments?post=619"}],"version-history":[{"count":1,"href":"https:\/\/blogs-staging.imperial.ac.uk\/ighi\/wp-json\/wp\/v2\/posts\/619\/revisions"}],"predecessor-version":[{"id":1577,"href":"https:\/\/blogs-staging.imperial.ac.uk\/ighi\/wp-json\/wp\/v2\/posts\/619\/revisions\/1577"}],"wp:attachment":[{"href":"https:\/\/blogs-staging.imperial.ac.uk\/ighi\/wp-json\/wp\/v2\/media?parent=619"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs-staging.imperial.ac.uk\/ighi\/wp-json\/wp\/v2\/categories?post=619"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs-staging.imperial.ac.uk\/ighi\/wp-json\/wp\/v2\/tags?post=619"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}