Fluid Therapy in Shock

Mandell, Deborah C.; King, Lesley G.

doi:10.1016/s0195-5616(98)50059-9

Cited by 14 publications

(27 citation statements)

References 28 publications

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“…20 Administration of a colloid has been recommended when the TS is less than 4.0 g/dL (less than 40 g/L) to avoid a clinically relevant decrease in colloid osmotic pressure (COP), 50 which may predispose to tissue and pulmonary edema, especially when additional crystalloid fluids are to be administered. During a traumatic event, sympathetic stimulation results in splenic contraction, especially in the dog, increasing the PCV and potentially giving the impression that hemorrhage has not occurred.…”

Section: Packed Cell Volume and Total Solids (Or Protein)mentioning

confidence: 99%

Monitoring Fluid Therapy and Complications of Fluid Therapy

Mathews¹

2012

Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

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Section: Packed Cell Volume and Total Solids (Or Protein)mentioning

confidence: 99%

Monitoring Fluid Therapy and Complications of Fluid Therapy

Mathews¹

2012

Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

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“…Unsolvable problems associated with blood transfusions in humans (primarily immunologic incompatibility and storage difficulties) led to the search for effective alternatives for volume replacement in the trauma patient, resulting in the production of physiological saline (0.9% NaCl) as the first isotonic crystalloid replacement solution in 1875 and lactated Ringer's solution (LRS) in the 1930s 1,2 . After the major blood types (1900, 1902) and rhesus factor (1939) were discovered in humans, blood transfusions regained popularity as a safe and effective resuscitative therapy in patients suffering from severe hemorrhage 1 ; however, restoration of circulatory blood volume with isotonic crystalloid solutions remains the mainstay of initial fluid therapy in hypovolemic shock, both in human 3–5 and veterinary medicine 6–9 …”

Section: Introductionmentioning

confidence: 99%

“…Poor tissue perfusion results in decreased oxygen delivery to organs leading to anaerobic metabolism and development of acidosis as tissue oxygen demands exceed supply. Tissue acidosis and increasing oxygen debt eventually progress to organ dysfunction and cell death 3,6,8,14 . The majority of trauma patients suffer injury‐induced hemorrhage, leading to hypovolemic shock, although patients may occasionally suffer primarily or additionally from cardiogenic, hypoxic, or distributive (primarily septic) shock as well 4 .…”

Section: Introductionmentioning

confidence: 99%

“…The majority of trauma patients suffer injury‐induced hemorrhage, leading to hypovolemic shock, although patients may occasionally suffer primarily or additionally from cardiogenic, hypoxic, or distributive (primarily septic) shock as well 4 . Based on our understanding of the pathophysiology of traumatic shock, 14 the primary goal of fluid therapy is restoration of adequate tissue perfusion and oxygenation 4–9,15,25–29 . Because a decrease in circulating blood volume below a critical level (e.g., hemorrhage in dogs resulting in a persistent systolic arterial blood pressure [SAP] below 45 mmHg) causes shock to become progressive and ultimately leads to irreversible multiple organ system failure, 30 it is generally accepted that treatment must be instituted immediately.…”

Section: Introductionmentioning

confidence: 99%

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Fluid therapy for the traumatized patient

Driessen

Brainard

2006

J Vet Emergen Crit Care

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Objective: To review the rationale behind and experiences with traditional and newly evolving concepts of fluid therapy in the traumatized patient, and to review conventional and novel fluid preparations for use in trauma resuscitation. Data sources: Human and veterinary clinical and research studies. Human data synthesis: Current treatment guidelines recommend aggressive fluid resuscitation with lactated ringers solution (LRS) or saline as optimum management of hemorrhagic shock in trauma, regardless of whether bleeding is controlled or not. The rationale behind this strategy is to restore intravascular volume as rapidly as possible to ensure adequate vital organ perfusion. Recently, this strategy has been challenged, especially in patients with uncontrolled hemorrhage, as neither laboratory evidence nor clinical trials support this practice. Current research indicates that vigorous fluid infusion may exacerbate bleeding and cause severe hemodilution, both impairing resuscitation outcome. As a result, a new line of thinking is emerging that balances the risks and benefits of intravenous volume infusion by offering the clinician alternative treatment strategies and emphasizes continuous endpoint‐oriented monitoring. ‘Hypotensive’ or ‘hypovolemic’ resuscitation techniques as well as initial volume replacement with fluids other than LRS or saline (e.g., hypertonic saline [HTS], HTS with dextran 70 [HTS‐D]) have been introduced in human medical practice as additional options for treatment of victims of trauma under certain circumstances. Clinical studies evaluating the use of hemoglobin‐based oxygen carriers (HBOCs) in the trauma setting are underway and may soon lead to an expansion of the fluid arsenal available to the clinician for treatment of trauma patients. Veterinary data synthesis: Based on available animal data, neither strict guidelines nor a clear fluid preference for resuscitation of traumatic shock have been defined. Although systematic clinical trials are missing, combinations of crystalloid and colloid (natural or artificial) appear to be as effective for resuscitation as crystalloid alone. Judicious use of an HBOC (e.g., Oxyglobin®) as a substitute for blood/red blood cells may be recommended in situations where whole blood or pRBCs are not or not yet available. Conclusions: The search for optimal methods of fluid resuscitation in trauma is ongoing. At this point the best solution is a differentiated approach to fluid therapy, one that tailors type and volume of resuscitation solution(s) used to the type and severity of injury in an individual patient and uses monitoring of perfusion and oxygenation parameters to guide resuscitation. Crystalloid fluids are effective for resuscitation but may need to be combined with or replaced by colloidal fluids in certain clinical situations.

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“…The experiments were designed prior to the initiation and not after completion of the study. As described in the Discussion , a return of HR, MAP and CVP to baseline as end points of volume replenishment was chosen because it reflects what is certainly most commonly encountered in veterinary clinical practice, where the placement of a balloon‐tipped pulmonary artery catheter and a physiologic monitor are not readily available except at large teaching hospitals or referral centers (Rudloff & Kirby, 1994; Mandell & King, 1998) and where more sophisticated data analysis including determinations of indexes for CI, SVI, O 2 delivery (DO 2 I), consumption (VO 2 I) and extraction ratio (ExO 2 ) to guide resuscitation is rarely practiced. Even in the human medical field Shoemaker (2000) describes arterial pressure, HR, hematocrit, urine output, CVP and pulmonary arterial wedge pressure as the clinical criteria most often used for adequate blood volume restoration.…”

mentioning

confidence: 99%