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VOLUME 10 , ISSUE 4 ( October, 2006 ) > List of Articles


Fluid resuscitation in trauma

A. Rudra, S. Chatterjee, S. Sengupta, S. Sirohia, R. Wankhade, T. Das

Keywords : Fluid therapy, resuscitation, body fluids, water-electrolyte balance, trauma

Citation Information : Rudra A, Chatterjee S, Sengupta S, Sirohia S, Wankhade R, Das T. Fluid resuscitation in trauma. Indian J Crit Care Med 2006; 10 (4):241-249.

DOI: 10.4103/0972-5229.29843

License: CC BY-ND 3.0

Published Online: 01-10-2006

Copyright Statement:  Copyright © 2006; Jaypee Brothers Medical Publishers (P) Ltd.


Appropriate fluid replacement is an essential component of trauma fluid resuscitation. Once hemorrhage is controlled, restoration of normovolemia is a priority. In the presence of uncontrolled haemorrhage, aggressive fluid management may be harmful. The crystalloid-colloid debate continues but existing clinical practice is more likely to reflect local biases rather than evidence based medicine. Colloids vary substantially in their pharmacology and pharmacokinetics, and the experimental finding based on one colloid cannot be extrapolated reliably to another. In the initial stages of trauma resuscitation the precise fluid used is probably not important as long as an appropriate volume is given. Later, when the microcirculation is ′leaky′, there may be some advantages to high or medium weight colloids such as hydroxyethyl starch. Hypertonic saline solutions may have some benefit in patients with head injuries. A number of hemoglobin solutions are under development, but one of the most promising of these has been withdrawn recently. It is highly likely that at least one of these solutions will eventually become routine therapy for trauma patient resuscitation. In the meantime, contrary to traditional teaching, recent data suggest that restrictive strategy of red cell transfusion may improve outcome in some critically ill patients.

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  1. Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, et al. Epidemiology of trauma deaths: A reassessment. J Trauma 1995;38:185-93.
  2. Acosta JA, Yang JC, Winchell RJ, Simons RK, Fortlage DA, Hollingsworth-Fridlund P, et al. Lethal injuries and time to death in a level 1 trauma centre. J Am Coll Surg 1998;186:528-33.
  3. Talving P, Palstedt J, Riddez L. Prehospital management and fluid resuscitation in hypotensive trauma patients admitted to Karolinska University hospital in Stockholm. Prehosp Disast Med 2005;20:228-34.
  4. Gillham MJ, Parr MJ. Resuscitation for major trauma. Curr Opin Anaesthesiol 2002;15:167-72.
  5. Blalock A. Acute circulatory failure as exemplified by shock and hemorrhage. Sur Gynecol Obstet 1934;58:551-6.
  6. Cannon W, Fraser J, Cowell E. Preventive treatment of wound shock. JAMA 1918;70:618-21.
  7. Keel M, Trenta O. Pathophysiology of polytrauma. Injury 2005;36:691-709.
  8. Shires GT, Barber AE, Ilner HP. Current status of resuscitation: Solutions including hypertonic saline. Adv Surg 1995;28:133-70.
  9. Cohn SM. Is blood obsolete? J Trauma 1997;42:730-2.
  10. Conhaim RL, Harms BA. Hemoglobin therapeutics in hemorrhagic shock. Curr Opin Crit Care 1998;4:422-6.
  11. Margarson MP, Soni N. Serum albumin: Touchstone or totem? Anaesthesia 1998;53:789-803.
  12. Haupt MT, Kaufman BS, Carlson RW. Fluid resuscitation in patients with increased vascular permeability. Crit Care Clin 1992;8:341-53.
  13. Dutton RP. Fluid management in the trauma patient. Crit Care Pain 2006;6:144-7.
  14. Cooper DJ, Myles PS, McDermott FT, Murray LJ, Laidlaw J, Cooper G, et al. Prehospital hypertonic saline resuscitation of patients with hypotention and severe traumatic brain injury. JAMA 2004;291:1350-7.
  15. Riddez L, Drobin D, Sjostrand F, Svensen C, Hahn RG. Lower dose of hypertonic saline dextran reduces the risk of lethal rebleeding in uncontrolled hemorrhage. Shock 2002;17:377-82.
  16. Dunham CM, Siegel JH, Weireter L, Fabian M, Goodarzi S, Guadalupi P, et al. Oxygen debt and metabolic acidaemia as quantitive predictors of mortality and the severity of the ischaemic insult in haemorrhagic shock. Crit Care Med 1991;19:231-43.
  17. Chiara O, Scott JD, Cimbanassi S, Marini A, Zoia R, Rodriguez A, et al. Trauma deaths in an Italian urban area: An audit of pre-hospital and in-hospital trauma care. Injury 2002;33:553-62.
  18. American Heart Association and American Academy of Pediatrics: Intraosseous infusion. In: Chameides L, editor. Textbook of Pediatric Advanced Life Support. American Heart Association: Dallas; 1988. p. 43-4.
  19. Dutton RP, McCunn M. Anaesthesia for trauma. In: Miller ER, editor. Miller′s Anaesthesia. 6th ed. Elsevier Churchill Livingstone: Philadelphia; 2005. p. 2459-69.
  20. Bickell WH, Wall MJ, Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 1994;331:1105-9.
  21. Lepaniemi A, Soltero R, Burris D, Pikoulis E, Waasdorp C, Ratigan J, et al. Fluid resuscitation in a model of uncontrolled haemorrhage: Too much too early or too little too late ? J Surg Res 1996;63:413-8.
  22. Kowalenko T, Stern S, Dronen S, Wang X. Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic shock in a swine model. J trauma 1992;33:349-53.
  23. National Institute of Clinical Excellence (NICE). Pre-hospital initiation of fluid replacement therapy in trauma. London, UK; 2004. p. 74-78.
  24. Sclea TM, Holman M, Fuortes M, Baron BJ, Phillips TF, Goldstein AS, et al. Central venous blood oxygen saturation: An early, accurate measurement of volume during hemorrhage. J Trauma 1988;28:725-32.
  25. Mikulaschek A, Henry SM, Donovan R, Scalea TM. Serum lactate is not predicted by anion gap or base excess after trauma resuscitation. J Trauma 1996;40:218-24.
  26. Bilkowsi RN, Rivers EP, Horts HM. Targeted resuscitation strategies after injury. Curr Opin Crit Care 2004;10:529-38.
  27. Tisherman SA, Barie P, Bokhari F, Bonadies J, Daley B, Diebel L, et al. Clinical practice guidelines: Endpoints of resuscitation. J Trauma 2004;57:898-912.
  28. Davis JW, Shackford SR, Holbrook TL. Base deficit as a sensitive indicator of compensated shock and tissue oxygen utilization. Surg Gynecol Obstet 1991;173:473-6
  29. Eberhard LW, Morabito DJ, Matthay MA, Mackersie RC, Campbell AR, Marks JD, et al. Initial severity of metabolic acidosis predicts the development of acute lung injury in severely traumatized patients. Crit Care Med 2000;28:125-31.
  30. Peterson DL, Schinco MA, Kerwin AJ, Griffen MM, Pieper P, Tepas JJ. Evaluation of initial base deficit as a prognosticator of outcome in the pediatric trauma population. Am Surg 2004;70:326-32.
  31. Randolph LC, Takacs M, Davis KA. Resuscitation in the pediatric trauma population: Admission base deficit remains an important prognostic indicator. J Trauma 2002;53:838-42.
  32. Vitek V, Cowley RA. Blood lactate in the prognosis of various forms of shock. Ann Surg 1971;173:308-13.
  33. Caplan LM, Miller SM. Trauma and burns. In: Barash PG, Cullen BF, Stoelting RK, editors. Clinical Anaesthesia. 5th ed. Lippincott Williams and Wilkins: Philadelphia; 2006. p. 1262-97.
  34. Baron BJ, Sinert R, Zehtabchi S, Stavile KL, Scalea TM. Diagnostic utility of sublingual PCO2 for detecting hemorrhage in penetrating trauma patients. J Trauma 2004;57:69-74.
  35. Madjdpour C, Spahn DR. Allogenic red blood cell transfusions: Efficacy, risks, alternatives and indications. Br J Anaesth 2005;95:33-42.
  36. Spahn SR, Raissaint R. Coagulopathy and blood component transfusion in trauma. Br J Anaesth 2005;95:130-9.
  37. Boldt J. Fluid choice for resuscitation of the trauma patient: A review of the physiological, pharmacological and clinical evidence. Can J Anaesth 2004;51:500-13.
  38. Drobin D, Hahn RG. Volume kinetics of Ringer′s solution in hypovolaemic volunteers. Anesthesiology 1999;90:81-91.
  39. Bock JC, Barker BC, Clinton AG, Wilson MB, Lewis FR. Post-traumatic changes in and effect of colloid osmotic pressure on the distribution of body water. Ann Surg 1989;210:395-405.
  40. Muckart DJ, Bhagwanjee S. American College of Chest Physicians/ Society of Critical Care Medicine Consensus Conference definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients. Crit Care Med 1997;25:1789-95.
  41. American Thoracic Society. Evidence-based colloid use in the critically ill: American Thoracic Society Consensus Statement. Am J Resp Crit Care Med 2004;170:1247-59.
  42. Boldt J, Heesen M, Muller M, Pabsdorf M, Hempelmann G. The effects of albumin versus hydroxyethyl starch solution on cardiorespiratory and circulatory variables in critically ill patients. Anesth Analg 1996;83:254-61.
  43. Schmand JF, Ayala A, Morrison MH, Chaudry IH. Effects of hydroxyethyl starch after trauma haemorrhagic shock: Restoration of macrophage integrity and prevention of increasing circulating interleukin-6 levels. Crit Care Med 1995;23:806-14.
  44. Haljamae H, Dahlquist M, Walentin F. Artificial colloids in clinical practice: Pros and cons. Bailliere′s Clin Anaesth 1997;11:49-79.
  45. Boldt J. The good, the bad and the ugly: Should we completely banish human albumin from our ICUs? Anesth Analg 2000;91:887-95.
  46. Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004;350:2247-56.
  47. Rocha E, Silva M. Hypertonic Saline resuscitation: A new concept. Bailliere′s Clin Anaesth 1997;11:127-42.
  48. Smith CE. Current practices in fluid and blood component therapy in trauma. In: Massive transfusion and control of hemorrhage in the trauma patient (accreditation council for containing medical education, ITACCS). 2003. p. 18-22.
  49. Werwath DJ, Schwab CW, Scholter JR. Microwave oven: A safe new method of warming crystalloids. Am J Surg 1984;12:656-9.
  50. Gentilello LM, Jurkovich GJ, Stark MS, Hassantash SA, O′Keefe GE. Is hypothermia in the victim of major trauma protective or harmful? A randomized, prospective study. Ann Surg 1997;226:439-49.
  51. Sessler DI. Mild perioperative hypothermia. N Engl J Med 1997;336:1730-7.
  52. Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A. Mild hypothermia increases blood loss and transfusion requirements during hip arthroscopy. Lancet 1996;347:289-92.
  53. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical wound infection and shorten hospitalization. N Engl J Med 1996;334:1209-15.
  54. Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. JAMA 1997;277:1127-34.
  55. Dahan E, Orbach S, Weiss YG. Fluid management in trauma. Int Anesthesiol Clin 2003;38:141-8.
  56. Tisherman SA. Regardless of origin, uncontrolled haemorrhage is uncontrolled haemorrhage. Crit Care Med 2000;28:892-4.
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