Fluid Resuscitation

Abstract

Hemorrhage remains a major cause of preventable death following both civilian and military trauma. The goals of resuscitation in the face of hemorrhagic shock are restoring end-organ perfusion and maintaining tissue oxygenation while attempting definitive control of bleeding. However, if not performed properly, resuscitation can actually exacerbate cellular injury caused by hemorrhagic shock, and the type of fluid used for resuscitation plays an important role in this injury pattern. This article reviews the historical development and scientific underpinnings of modern resuscitation techniques. We summarized data from a number of studies to illustrate the differential effects of commonly used resuscitation fluids, including isotonic crystalloids, natural and artificial colloids, hypertonic and hyperoncotic solutions, and artificial oxygen carriers, on cellular injury and how these relate to clinical practice. The data reveal that a uniformly safe, effective, and practical resuscitation fluid when blood products are unavailable and direct hemorrhage control is delayed has been elusive. Yet, it is logical to prevent this cellular injury through wiser resuscitation strategies than attempting immunomodulation after the damage has already occurred. Thus, we describe how some novel resuscitation strategies aimed at preventing or ameliorating cellular injury may become clinically available in the future.

Hypertonic Saline Primes Activation of the p53–p21 Signaling Axis in Human Small Airway Epithelial Cells That Prevents Inflammation Induced by Pro-inflammatory Cytokines

“…5–8 These clinical studies were recently supported by in vitro evidence, indicating a significant anti-inflammatory benefit of HTS. 9–11 By the alteration of ionicity and osmolarity, thus causing fluid shifts, 12 HTS could be leveraged for clinical applications such as a mucolytic agent in cystic fibrosis in children 13 or proposed as a treatment to decrease brain swelling after traumatic brain injury. However, the mechanisms underlying the beneficial effects observed in HTS-treated patients remain elusive.…”

Selective histone deacetylase 6 inhibition prolongs survival in a lethal two-hit model

“…The concept of two-hit insult has been increasingly accepted as an explanation for the development of multiple organ dysfunction syndrome in the trauma patients [3]. In recent years, we have moved away from aggressive crystalloid resuscitation for the treatment of hemorrhagic shock due to accumulating pre-clinical and clinical data about its adverse consequences [10–12]. The contemporary trauma care now is based upon the concept of Damage Control Resuscitation, which limits use of crystalloids, promotes early blood product use, and prompt hemorrhage control [13, 14].…”

Protective effects of polyethylene oxide on the vascular and organ function of rats with severe hemorrhagic shock

“…Isotonic crystalloids, colloids, and hypertonic solutions, which have been confirmed to improve the hemodynamic parameters of shock patients to varying degrees, were commonly used in fluid resuscitation during the past half century (Santry and Alam 2010;Perel et al 2013). In recent years however, there has been increasing evidence that different fluids had widely divergent negative impacts on the immune response, inflammation, neutrophil activation, cellular dysfunction, and tissue injury, and the type of fluid used for resuscitation plays an important role in the injury pattern (Alam et al 2004;Santry and Alam 2010). Rhee et al (2000) reported that isotonic crystalloid solutions might actually aggravate the immune dysfunction of patients subjected to hemorrhage and hemorrhagic shock (hereinafter "shocked patients").…”