The FEAST (Fluid Expansion as Supportive Therapy) trial was a randomized fluid bolus trial in over 3000 children presenting with severe febrile illness and poor peripheral perfusion to hospitals in sub-Saharan Africa.

In short, standard rapid bolus fluids of 20 ml/kg worsened mortality rates at 48 hours.

This trial has raised debate about defining shock in such children, the differing patterns of presentation in Sub-Saharan Africa and the pathophysiology of shock in disparate conditions.

Children with severe malnutrition, gastroenteritis, burns, trauma and surgery were excluded from the study.

Surgical patients almost certainly continue to do well with standard resuscitation recommendations. However, fluid therapy should be more cautiously administered to children presenting with anaemia, likely malaria, severe respiratory illness or cerebral impairment, including meningitis.