New perspectives of volemic resuscitation in polytrauma patients: a review

Abstract

Nowadays, fluid resuscitation of multiple trauma patients is still a challenging therapy. Existing therapies for volume replacement in severe haemorrhagic shock can lead to adverse reactions that may be fatal for the patient. Patients presenting with multiple trauma often develop hemorrhagic shock, which triggers a series of metabolic, physiological and cellular dysfunction. These disorders combined, lead to complications that significantly decrease survival rate in this subset of patients. Volume and electrolyte resuscitation is challenging due to many factors that overlap. Poor management can lead to post-resuscitation systemic inflammation causing multiple organ failure and ultimately death. In literature, there is no exact formula for this purpose, and opinions are divided. This paper presents a review of modern techniques and current studies regarding the management of fluid resuscitation in trauma patients with hemorrhagic shock. According to the literature and from clinical experience, all aspects regarding post-resuscitation period need to be considered. Also, for every case in particular, emergency therapy management needs to be rigorously respected considering all physiological, biochemical and biological parameters.

Impact of General Anaesthesia - Guided by State Entropy (SE) and Response Entropy (RE) on Perioperative Stability in Elective Laparoscopic Cholecystectomy Patients. A Prospective Observational Randomized Monocentric Study

“…They have also shown the lack of cognitive imbalance later on, but with no significant differences at 7 days (p = 0.062), and at 90 days (p = 0.372) [46]. Postoperative complication rate has been shown to vary between 20% and 42% [47]; they have an impact both on the clinical outcome of patients, as well as on the OR management and patient outflow [48]. This is due to longer times of stay in the recovery room and longer hospital length of stay [49][50][51][52].…”

Impact of General Anesthesia Guided by State Entropy (SE) and Response Entropy (RE) on Perioperative Stability in Elective Laparoscopic Cholecystectomy Patients—A Prospective Observational Randomized Monocentric Study

“…They also showed the lack of cognitive imbalance later on, but with no significant differences at 7 days (p = 0.062) and at 90 days (p = 0.372) [ 46 ]. Post-operative complication rate has been shown to vary between 20% and 42% [ 47 ]; they have an impact both on the clinical outcome of patients as well as on the OR management and patient outflow [ 48 ]. This is due to longer times of stay in the recovery room and a longer hospital length of stay [ 49 , 50 , 51 , 52 ].…”

Assessment of Metabolic and Nutritional Imbalance in Mechanically Ventilated Multiple Trauma Patients: From Molecular to Clinical Outcomes

“…Recent studies have shown that hypercholesterolemia can be an important index for negative prognosis in these patients, especially because of the complex interactions that cholesterol has with protein fragments in plasma. Moreover, it has been noticed that hypercholesterolemia interfaces with the augmentation of the systemic inflammatory response [69]. Chiarla et al conducted a study in order to identify correlations between plasmatic cholesterol levels and a series of metabolic changes in septic patients.…”