***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Objective Both albumin and synthetic colloids such as hydroxyethyl starch ( HES ) solution are used to optimize hemodynamics in the critically ill . The influence of different long-term infusion regimes on platelet function was studied . Design Prospect i ve , r and omized study . Setting Clinical investigation on a university hospital surgical intensive care unit . Patients Twenty-eight consecutive trauma patients ( injury severity score>15 points ) and 28 consecutive nontraumatized surgical patients with sepsis . Interventions The patients received either 20 % human albumin ( HA trauma , n=14 ; HA sepsis , n=14 ) or 10 % low-molecular-weight HES solution HES 200/0.5 ( HES trauma , n=14 ; HES sepsis;n=14 ) for 5 days to maintain central venous pressure and /or pulmonary capillary wedge pressure between 12 and 16 mmHg . Measurements and results Platelet function was assessed by aggregometry ( = turbidimetric technique ) using adenosine diphosphate 2.0 μmol/l , collagen 4 μl/ml , and epinephrine 25 μmol/l as inductors . Arterial blood was sample d on the day of admission or the day of diagnosis of sepsis ( = baseline value ) and over the next 5 days . St and ard coagulation parameters ( antithrombin III , fibrinogen , partial thromboplastin time ) were also measured . Total use of HES by the 5th day totalled 4870±990 ml in the trauma and 3260±790 ml in the sepsis patients ( HA trauma : 1850±380 ml ; HA sepsis : 1790±400 ml ) . Maximum platelet aggregation decreased significantly during the first 2–3 days after baseline in all groups . At the end of the investigation period , platelet aggregation variables had recovered and reached ( or even exceeded ) baseline values . Within the entire investigation period , the course of platelet aggregation variables did not differ significantly between HA and HES-treated patients irrespective of whether they were trauma or sepsis patients . Conclusions Alterations in hemostasis may occur for several reasons in the critically ill . Human albumin is the preferred first-line volume therapy in patients at risk for coagulation disorders . With respect to platelet function , volume replacement with ( lower-priced ) low-molecular-weight HES solutions can be recommended in this situation without any risk BACKGROUND In a single-center study published more than a decade ago involving patients presenting to the emergency department with severe sepsis and septic shock , mortality was markedly lower among those who were treated according to a 6-hour protocol of early goal -directed therapy ( EGDT )  , in which intravenous fluids , vasopressors , inotropes , and blood transfusions were adjusted to reach central hemodynamic targets , than among those receiving usual care . We conducted a trial to determine whether these findings were generalizable and whether all aspects of the protocol were necessary . METHODS In 31 emergency departments in the United States , we r and omly assigned patients with septic shock to one of three groups for 6 hours of resuscitation : protocol -based EGDT ; protocol -based st and ard therapy that did not require the placement of a central venous catheter , administration of inotropes , or blood transfusions ; or usual care . The primary end point was 60-day in-hospital mortality . We tested sequentially whether protocol -based care ( EGDT and st and ard-therapy groups combined ) was superior to usual care and whether protocol -based EGDT was superior to protocol -based st and ard therapy . Secondary outcomes included longer-term mortality and the need for organ support . RESULTS We enrolled 1341 patients , of whom 439 were r and omly assigned to protocol -based EGDT , 446 to protocol -based st and ard therapy , and 456 to usual care .  Resuscitation strategies differed significantly with respect to the monitoring of central venous pressure and oxygen and the use of intravenous fluids , vasopressors , inotropes , and blood transfusions . By 60 days , there were 92 deaths in the protocol -based EGDT group ( 21.0 % ) , 81 in the protocol -based st and ard-therapy group ( 18.2 % ) , and 86 in the usual-care group ( 18.9 % ) ( relative risk with protocol -based therapy vs. usual care , 1.04 ; 95 % confidence interval [ CI ] , 0.82 to 1.31 ; P=0.83 ; relative risk with protocol -based EGDT vs. protocol -based st and ard therapy , 1.15 ; 95 % CI , 0.88 to 1.51 ; P=0.31 ) . There were no significant differences in 90-day mortality , 1-year mortality , or the need for organ support . CONCLUSIONS In a multicenter trial conducted in the tertiary care setting , protocol -based resuscitation of patients in whom septic shock was diagnosed in the emergency department did not improve outcomes . ( Funded by the National Institute of General Medical Sciences ; ProCESS Clinical Trials.gov number , NCT00510835 . ) Background : It is unknown whether fluid resuscitation with colloid or crystalloid in patients with severe sepsis or septic shock is associated with an improvement in clinical outcome . This r and omized controlled trial determined the feasibility of conducting a large trial testing resuscitation with pentastarchvs normal saline in early septic shock , powered for a difference in mortality . Methods : At three Canadian and one New Zeal and academic centre , 40 patients with early septic shock defined by at least two systemic inflammatory response syndrome criteria , infectious source , and persistent hypotension after ≥ 1 L of crystalloid fluid were recruited . Feasibility measures were patient recruitment , blinding of the study fluids , and acceptability of the goal directed algorithms . Boluses of blinded normal saline or pentastarch ( 500 mL − maximum 3 L or 28 mL·kg−1 ) were administered within goal directed care for the first 12 hr . Results : Of 161 patients screened , 121 were excluded and 40 patients were enrolled , for a recruitment rate of 0.75 patients / site/month . Only 57 % of physicians and 54 % of nurses correctly guessed the study fluid ( P = 0.46 and P = 0.67 , respectively ) . The goal directed algorithms were acceptable to 97 % of physicians . Conclusion : The ability to recruit patients in this pilot r and omized controlled trial was below expectations . Blinding of study fluids was adequate , and resuscitation algorithms were acceptable to most physicians . Methods to improve recruitment are required to enhance the feasibility of conducting a multicentre fluid resuscitation trial in early septic shock . Résumé Context e : Nous ne savons pas si la réanimation liquidienne avec des colloïdes ou des cristalloïdes chez les patients présentant un sepsis grave ou un choc septique est associée à un devenir clinique meilleur . Cette étude r and omisée contrôlée a déterminé la faisabilité d’une étude d’envergure testant la réanimation avec le pentastarch par rapport au sérum physiologique en début de choc septique , avec pour objectif primaire de détecter une différence dans les taux de mortalité . Method e : Quarante patients en début de choc septique , défini comme au moins deux critères du syndrome de réaction inflammatoire , une source d’infection et une hypotension persistante après ≥ 1 L de cristalloïde ont été recrutés dans trois centres universitaires canadiens et un centre néo-zél and ais . Les mesures de faisabilite étaient : le recrutement des patients , le masquage des liquides à l’étude , et I’acceptabilité des algorithmes dirigés vers des objectifs . Des bolus de normal sal in ou de pentastarch ( 500 mL — maximum 3 L ou 28 mL·kg−1 ) ont été administrés en aveugle dans le cadre de soins guidés dirigés vers des objectifs durant les 12 premieres heures . Result ats : Sur 161 patients dépistés , 121 ont été exclus et 40 patients recrutés dans le cadre de I’étude , avec un taux de recrutement de 0,75 patient/site/mois . Seulement 57 % des médecins et 54 % des infirmières ont réussi à deviner correctement le type de liquide à I’étude ( P = 0,46 etP = 0,67 , respectivement ) . Les algorithmes ont été jugés acceptables par 97 % des médecins . Conclusion : La capacité à recruter des patients pour cette étude pilote r and omisée contrôlée était moins importante qu’attendue . Le masquage des liquides était satisfaisant , et les algorithmes de réanimation ont été jugés acceptables par la majorité des médecins . Des méthodes dans le but d’améliorer le recrutement sont nécessaire pour accroître la faisabilité d’une étude multicentrique sur la réanimation liquidienne en début de choc septique Symptomatic severe malarial anaemia ( SMA ) has a high fatality rate of 30–40 % ; most deaths occur in children awaiting blood transfusion . Blood transfusion services in most of Africa are not capable of delivering adequate supplies of safe blood in a timely manner to critically ill children with SMA . Contrary to widely held belief , hypovolaemia , rather than heart failure , has emerged as a common complication in such children . We examined the safety of  pre‐transfusion management ( PTM )  by volume expansion , aim ed at stabilizing children and obviating the urgency for blood transfusion . Kenyan children with severe falciparum anaemia ( haemoglobin < 5 g/dl ) and respiratory distress were r and omly assigned to 20 ml/kg of 4·5 % albumin or 0·9 % saline or maintenance only ( control ) while awaiting blood transfusion . PTM was apparently safe since it did not lead to the development of pulmonary oedema or other adverse events . There was no significant difference in the primary outcome [ mean percentage reduction in base excess between admission and 8 h ( 95 % confidence interval ) ] between the control group 42 % ( 19–66 % ) albumin group 44 % ( 32–57 % ) and saline group 36 % ( 16–57 % ) ; adjusted analysis of variance F = 0·31 , P = 0·7 . However , the number of children requiring emergency interventions was significantly greater in the control group , four of 18 ( 22 % ) than the saline group 0 of 20 ( P = 0·03 ) . We have established the safety of this PTM in children with SMA whilst awaiting blood transfusion at a hospital with an adequate blood‐banking program . The impact on mortality should be assessed where blood transfusion services are unable to supply emergency transfusions BACKGROUND The role of fluid resuscitation in the treatment of children with shock and life-threatening infections who live in re source -limited setting s is not established . METHODS We r and omly assigned children with severe febrile illness and impaired perfusion to receive boluses of 20 to 40 ml of 5 % albumin solution ( albumin-bolus group ) or 0.9 % saline solution ( saline-bolus group ) per kilogram  of  body weight or no bolus ( control group ) at the time of admission to a hospital in Ug and a , Kenya , or Tanzania ( stratum A ) ; children with severe hypotension were r and omly assigned to one of the bolus groups only ( stratum B ) . All children received appropriate antimicrobial treatment , intravenous maintenance fluids , and supportive care , according to guidelines . Children with malnutrition or gastroenteritis were excluded . The primary end point was 48-hour mortality ; secondary end points included pulmonary edema , increased intracranial pressure , and mortality or neurologic sequelae at 4 weeks . RESULTS The data and safety monitoring committee recommended halting recruitment after 3141 of the projected 3600 children in stratum A were enrolled . Malaria status ( 57 % overall ) and clinical severity were similar across groups . The 48-hour mortality was 10.6 % ( 111 of 1050 children ) , 10.5 % ( 110 of 1047 children ) , and 7.3 % ( 76 of 1044 children ) in the albumin-bolus , saline-bolus , and control groups , respectively ( relative risk for saline bolus vs. control , 1.44 ; 95 % confidence interval [ CI ] , 1.09 to 1.90 ; P=0.01 ; relative risk for albumin bolus vs. saline bolus , 1.01 ; 95 % CI , 0.78 to 1.29 ; P=0.96 ; and relative risk for any bolus vs. control , 1.45 ; 95 % CI , 1.13 to 1.86 ; P=0.003 ) . The 4-week mortality was 12.2 % , 12.0 % , and 8.7 % in the three groups , respectively ( P=0.004 for the comparison of bolus with control ) . Neurologic sequelae occurred in 2.2 % , 1.9 % , and 2.0 % of the children in the respective groups ( P=0.92 ) , and pulmonary edema or increased intracranial pressure occurred in 2.6 % , 2.2 % , and 1.7 % ( P=0.17 ) , respectively . In stratum B ,  
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AUTHORS ' CONCLUSIONS No studies compared liberal versus conservative fluid therapy in adults .
Low- to high- quality evidence indicates that liberal fluid therapy might increase mortality among children with sepsis or septic shock in hospital and at four-week follow-up .