Kath Maitland takes the perspective that we should be cautious
with how we give IV fluids. She argues that the underlying
physiological evidence supporting the benefits of giving fluids is
not there. The findings of the FEAST study are clear. Kath
describes how during FEAST, the administration of fluids made the
children look better, and improved the recorded physiological
parameters. However these surrogate outcomes did not translate to a
mortality benefit - fluid boluses were associated with increased
mortality.
Nick, a paeds intensivist, retaliates with how it's really about
understanding physiology. He defends the position we take at the
moment and discusses the issues with the parameters used to assess
fluid responsiveness, but urges that we shouldn't change everything
we do at the moment until we understand the physiology better. He
also has nice description of the glycocalyx - "the pubic hair of
the blood vessels, only more useful".