Contact information
Type
Scientific
Contact name
Dr Kathryn Maitland
ORCID ID
Contact details
KEMRI Wellcome Trust Unit
Kilifi
P.O Box 230-801
Kenya
+254 41 7522063
kmaitland@kilifi.kemri-wellcome.org
Additional identifiers
EudraCT/CTIS number
IRAS number
ClinicalTrials.gov number
Protocol/serial number
MRC ref: G0801439
Study information
Scientific title
A randomised trial of fluid resuscitation strategies in African children with severe febrile illness and clinical evidence of impaired perfusion
Acronym
FEAST
Study hypothesis
In hospitals throughout sub-Saharan Africa, mortality from malaria and other severe infections in childhood remains at 15-30%, with over 50% of deaths occurring within 24 hours of admission. Currently, antimalarial and antimicrobial drugs are the mainstay of treatment, with little consideration being given to the use of adjunctive supportive therapies. There is considerable debate about the degree to which intravascular volume depletion (hypovolaemia) contributes to the pathophysiology of malaria and other severe infections, and clinical practice varies widely across the continent. To resolve the continuing uncertainty, this multi-centre randomised clinical trial will evaluate different fluid resuscitation strategies in children presenting to hospital with severe febrile illness and clinical evidence of impaired perfusion, with the intention of generating data of practical value to clinicians working in resource-poor settings in Africa.
Ethics approval(s)
1. Imperial College Research Ethics Committee (UK), approved in August 2008 (ref: ICREC_8_1_1)
2. Kenya Medical Research Institute (KEMRI) National Ethics Review Committee (Kenya), approved in July 2008 (ref: SCC 1355)
3. National Ethics Review Committee, Makarere University (Uganda) approved in April 2008
4. NIMRI Ethics Review Board (Tanzania), approved in September 2008 (ref: 748)
Study design
Open randomised controlled trial
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Study setting(s)
Not specified
Study type
Treatment
Patient information sheet
Not available in web format, please use the contact details provided in the Interventions field to request a patient information sheet.
Condition
Severe illness with shock due to sepsis or severe malaria
Intervention
This is a three-arm randomised open controlled trial comparing two active fluid resuscitation strategies to control (no bolus). 2,880 children will be assigned in a ratio of 1:1:1 to one of the three fluid management arms; 144 with decompennsated shock will be randomised to human albumin solution (HAS) or saline.
Three resuscitation strategies:
1. Immediate volume resuscitation with normal (0.9%) saline
2. Immediate volume expansion with 5% human albumin solution (HAS)
3. No immediate volume expansion (control)
Children will be assessed for neurological deficit at 28 days from date of randomisation. A further assessment will be conducted at six months only in children with a persistent neurological sequelae at 28 days.
Please use the following contact details to request a patient information sheet:
Study Coordinator: Dr Mukami Mbogo
KEMRI Wellcome Trust Programme
P.O. Box 230-80108
Kilifi
Kenya
Tel: +254 41 7522063
Fax: +254 41 7522390
Email: mmbogo@kilifi.kemri-wellcome.org
Intervention type
Other
Primary outcome measure
In-hospital mortality at 48 hours after randomisation.
Secondary outcome measures
1. Mortality at 4 weeks after randomisation
2. Mortality or neurological sequelae at 4 weeks after randomisation
3. Neurological sequelae at 4 weeks after randomisation
4. Persistent neurological sequelae at 6 months after randomisation
5. Development of hypotensive shock within 48 hours of randomisation
6. Adverse event within 48 hours of randomisation (pulmonary oedema, intracranial hypertension, severe allergic reaction in those receiving albumin)
Overall study start date
15/12/2008
Overall study end date
01/12/2011
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
Children (both males and females, age range >60 days and <12 years) with severe illness and clinical evidence of impaired perfusion in whom there is uncertainty as to the benefits of immediate fluid resuscitation and what type of fluid to give.
Severe illness and impaired perfusion defined as follows:
1. Severe illness: one or more of the following:
1.1. Impaired consciousness: prostration or coma
1.2. Respiratory distress
Prostration: inability to sit unsupported, or to breast feed if < 9months
Coma: inability to localise a painful stimulus
Respiratory distress: Deep breathing or increased work of breathing
2. Impaired perfusion: one or more of the following:
2.1. Capillary refill time >2s
2.2. Lower limb temperature gradient
2.3. Weak radial pulse volume
2.4. Severe tachycardia
Severe tachycardia: if <12 months: >180 bpm; 12 months to 5 years: >160 bpm; >5 years: >140 bpm
Participant type(s)
Patient
Age group
Child
Lower age limit
60 Days
Upper age limit
12 Years
Sex
Both
Target number of participants
2,880
Total final enrolment
3141
Participant exclusion criteria
One or more of the following at admission:
1. Severe acute malnutrition
2. Gastroenteritis
3. Conditions where intravascular volume expansion is contraindicated, namely chronic renal failure, pulmonary oedema
4. Non-infectious causes of severe illness: trauma, burns, intoxication
5. Children who have already received volume expansion using an isotonic volume expander during the current illness
Severe malnutrition: visible severe wasting and/or kwashiorkor
Gastroenteritis: >3 watery stools in previous 24 hours
Pulmonary oedema: oxygen saturation <90% on pulse oximetry plus bilateral basal crepitations
Recruitment start date
15/12/2008
Recruitment end date
01/12/2011
Locations
Countries of recruitment
Kenya, Tanzania, Uganda
Study participating centre
KEMRI Wellcome Trust Unit
Kilifi
P.O Box 230-801
Kenya
Sponsor information
Organisation
Imperial College of Science, Technology and Medicine (UK)
Sponsor details
Exhibition Road
London
SW7 2AZ
England
United Kingdom
-
m.cranmer@imperial.ac.uk
Sponsor type
University/education
Website
ROR
Funders
Funder type
Government
Funder name
Medical Research Council (UK) (ref: G0801439)
Alternative name(s)
UK Medical Research Council, MRC
Funding Body Type
government organisation
Funding Body Subtype
National government
Location
United Kingdom
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Individual participant data (IPD) sharing plan
IPD sharing plan summary
Not provided at time of registration
Study outputs
Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
---|---|---|---|---|---|
Results article | results | 30/06/2011 | Yes | No | |
Results article | results | 14/03/2013 | Yes | No | |
Results article | results | 01/07/2019 | 17/06/2019 | Yes | No |