Introduction
In the field of fluid resuscitation even century old debates are leaving us without right answers. ... The aim of this paper is not to become comprehensive global overview of fluid resuscitation, but to point out some practical dilemmas that are arising in a clinical and educational practice.
Question that already caused heated discussions is prehospital fluid resuscitation especially in penetrating torso trauma need to be discussed. ... Trauma patient needs volume replacement, the question is how soon.
Another question is how much fluid should we or can we give in prehospital period. Type of fluid is another dilemma that was debated over and over. ...
At the end what is the end point of the resuscitation. ... What will do more harm anemia in volume resuscitated patient or vasoconstriction in GIT in unresuscitated patient with the haemoconcentration?
Notorious Bickell`s study showed grater survival in delayed resuscitation group of patient compared with immediate resuscitation group. This study was criticized for number of formal reasons, but at the end, even if there is no difference between the delayed and immediate resuscitation groups it does raise the question of usefulness of fluid resuscitation in a field.
European experience with predominance of blunt trauma is that patients benefit from advanced life support in field. ... Unfortunately the study because of its retrospective design couldnt show the influence of fluid resuscitation on patient survival. ... Aggressive fluid resuscitation is mostly questioned, but there are also different opinions that regard prehospital advanced life support necessary especially in some circumstances. ... Patients with traumatic brain injury (TBI) would benefit from fluid resuscitation. ... These changes in the intestinal microcirculation are in concert with the "two-hit" theory for MSOF
Human data regarding the success of traditional aggressive fluid resuscitation are at best inconclusive. It is not clear if we actually prevent gut ischemia with early fluid resuscitation. Some animal studies have shown that hepatic and gut vascular beds are better perfused when resuscitation from hemorrhage is guided by systemic oxygen transport measurements compared to resuscitation guided by blood pressure. Aggressive fluid resuscitation results in hemodillution that does not improve oxygen delivery.
Animal models of uncontrolled hemorrhage mostly show better survival with moderate fluid resuscitation. ... Moderate fluid administration increased total hepatic blood flow. In contrast, increasing resuscitation volume did not improve hemodynamic parameters or regional perfusion. In other study large volume isotonic resuscitation using 80 ml/kg lactated Ringer solution lowered mortality rates from 76% (no resuscitation) and 71% (40 ml/kg) to 24%.
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