Appropriate Fluid Resuscitation for Shock in Severely Malnourished Children


The main objective of the project is to evaluate the safety, efficacy and feasibility of both the MSF guidelines and early, goal-directed appropriate fluid resuscitation (AFR) in the early treatment of shock in severely malnourished children.


Case fatality rates of children with severe malnutrition in resource limited settings are still unacceptably high. In a high proportion of these children mortality occurs within the first 24-48 hours after hospital admission. This early mortality is frequently associated with circulatory failure due to septic or hypovolaemic shock, suggesting that both early recognition and treatment of shock in these children can be improved. Tissue hypoxia is a key element of shock in the progression to multi-organ failure and death, which occurs in the critical ‘golden hours’. Therefore, most benefit of fluid resuscitation is to be expected when circulatory insufficiency is recognized and treated at an early stage. However, in severe malnourished children both recognition and treatment of circulatory insufficiency may be complex and has been subject of continuous controversy.
In order the address the above described problems, three different studies will be done. The first will be an observational study in 30 severely malnourished children in shock managed according to the MSF guidelines under strict hemodynamic monitoring. The second study will be similar to study 1 only that the 30 severely malnourished children will receive AFR instead of the ‘MSF guidelines’ The results of these studies will allow us evaluate the safety of the MSF guidelines and the AFR regime, and may give us some indication of efficacy of both regimes. Finally, if indicated by findings in from initial studies we plan to conduct a third study: a randomized controlled trial to compare the efficacy and feasibility of AFR vs MSF guidelines in preventing early death in severe malnourished children in shock.


Name: AFRIM: Appropriate Fluid Resuscitation for Shock in Severely Malnourished Children


Principal Investigator:

Dr. J.B.M. van Woensel


– Centre for Geographic Medicine Research (Coast)  Kenya Medical Research Institute, Kilifi, Kenya

– Department of Paediatrics, Faculty of Medicine, Imperial College, London, United Kingdom

– Wellcome Trust Centre for Clinical Tropical Medicine, Imperial College, London, United Kingdom

Contact information:

Project Manager: Friso Janssen



Start date: 1 July 2011

Duration: 36 months

End date: 1 July 2014

Funded by:

Artsen zonder grenzen (MSF)

  • Kenya