Indian Journal of Critical Care Medicine
Medknow Publications on behalf of the Indian Society of Critical Care Medicine
Vol. 10, No. 4, 2006, pp. 241-249
Bioline Code: cm06034
Full paper language: English
Document type: Research Article
Document available free of charge
Indian Journal of Critical Care Medicine, Vol. 10, No. 4, 2006, pp. 241-249
© Copyright 2006 Indian Journal of Critical Care Medicine.
Fluid resuscitation in trauma|
Rudra A, Chatterjee S, Sengupta S, Wankhade R, Sirohia S, Das T
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 A number of hemoglobin solutions are under development, but one of the most promising of these has been withdrawn recently.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.
Fluid therapy, resuscitation, body fluids, water-electrolyte balance, trauma
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