Optimal fluid resuscitation in trauma: Type, timing, and total

Marcie Feinman, Bryan A. Cotton, Elliott R. Haut

Research output: Contribution to journalReview article

Abstract

PURPOSE OF REVIEW: This review article explores the recent literature regarding the optimal type and amount of intravenous fluids for the trauma patient from the time of injury through their ICU stay. It discusses damage control principles as well as targeted resuscitation utilizing new technology. RECENT FINDINGS: In the prehospital arena, intravenous fluids have been associated with worse patient outcomes due to increased coagulopathy and time to definitive care. Once in the trauma bay, damage control resuscitation principles apply to the severely injured patient. Large volume crystalloid infusion increases mortality. The best patient outcomes have been found with transfusion of blood products in a ratio that closely mimics whole blood. Thrombelastography is a useful adjunct in resuscitation and can help guide the judicious use of blood products. New technology can help providers ascertain when a patient is appropriately resuscitated by determining adequate global and regional perfusion. SUMMARY: During the resuscitation of the acutely injured patient, crystalloids should be limited in favor of blood components. Damage control principles apply until definitive hemostasis is obtained, at which point the focus should change to targeted resuscitation using traditional global endpoints of resuscitation in conjunction with determinants of regional perfusion.

Original languageEnglish (US)
Pages (from-to)366-372
Number of pages7
JournalCurrent opinion in critical care
Volume20
Issue number4
DOIs
StatePublished - Aug 2014

Keywords

  • Fluid resuscitation
  • Hemorrhage
  • Shock
  • Trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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