Fluid resuscitation: past, present, and the future.
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.
Santry
Heena P
HP
Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA.
Alam
Hasan B
HB
D000818:Animals; D001802:Blood Substitutes / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003102:Colloids / Q000009:adverse effects / Q000627:therapeutic use; D000077324:Crystalloid Solutions; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006454:Hemoglobins / Q000627:therapeutic use; D006470:Hemorrhage / Q000517:prevention & control; D056572:Histone Deacetylase Inhibitors / Q000627:therapeutic use; D006801:Humans; D007552:Isotonic Solutions / Q000009:adverse effects / Q000627:therapeutic use; D015532:Rehydration Solutions / Q000009:adverse effects; D012151:Resuscitation / Q000379:methods*; D000077325:Ringer's Lactate; D012771:Shock, Hemorrhagic / Q000503:physiopathology / Q000628:therapy*
D001802:Blood Substitutes; D003102:Colloids; D000077324:Crystalloid Solutions; D006454:Hemoglobins; D056572:Histone Deacetylase Inhibitors; D007552:Isotonic Solutions; D015532:Rehydration Solutions; D000077325:Ringer's Lactate; C096798:HBOC 201