Each publication from Maitland, et al., gives us a glimpse of a greater medical truth, but our view is obstructed by questions about external validity.

This group published the landmark FEAST trial that questioned the safety and utility of one of the most ubiquitous interventions in medicine today, the fluid bolus.

The authors enrolled 3141 pediatric sepsis patients at six clinical centers in Africa, and patients were randomized to receive an IV fluid bolus (saline or albumin) plus a continuous infusion or infusion alone.

The results were surprising, to say the least.

The trial was stopped premature of its 3,600 predetermined sample size because of an increased rate of 48-hour mortality, 10.6%, 10.5%, and 7.3% in the albumin-bolus, saline-bolus, and no bolus control groups, respectively.

This was the first trial empirically examining the efficacy of a fluid bolus for septic shock, and the authors found that IV fluid boluses were associated with increased 48-hour and 28-day mortality.

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