Abstract
Fluids are a vital tool in the armament of acute care clinicians in both civilian and military resuscitation. We now better understand complications from inappropriate resuscitation with currently available fluids; however, fluid resuscitation undeniably remains a life-saving intervention. Military research has driven the most significant advances in the field of fluid resuscitation and is currently leading the search for the fluids of the future. The veterinary community, much like our civilian human counterparts, should expect the fluid of the future to be the fruit of military research. The fluids of the future not only are expected to improve patient outcomes but also be field expedient. Those fluids should be compatible with military environments or natural disaster environments. For decades, military personnel and disaster responders have faced the peculiar demands of austere environments, prolonged field care, and delayed evacuation. Large scale natural disasters present field limitations often similar to those encountered in the battlefield. The fluids of the future should, therefore, have a long shelf-life, a small footprint, and be resistant to large temperature swings, for instance. Traumatic brain injury and hemorrhagic shock are the leading causes of preventable death for military casualties and a significant burden in civilian populations. The military and civilian health systems are focusing efforts on field-expedient fluids that will be specifically relevant for the management of those conditions. Fluids are expected to be compatible with blood products, increase oxygen-carrying capabilities, promote hemostasis, and be easy to administer in the prehospital setting, to match the broad spectrum of current acute care challenges, such as sepsis and severe systemic inflammation. This article will review historical military and civilian contributions to current resuscitation strategies, describe the expectations for the fluids of the future, and describe select ongoing research efforts with a review of current animal data.
Highlights
Specialty section: This article was submitted to Comparative and Clinical Medicine, a section of the journal Frontiers in Veterinary Science
Hemorrhagic shock, traumatic brain injury, burns, and sepsis are responsible for the vast majority of combat casualties from the most recent conflicts in the Middle East [1,2,3]
Hemorrhagic shock and sepsis are concerning in those patients
Summary
Specialty section: This article was submitted to Comparative and Clinical Medicine, a section of the journal Frontiers in Veterinary Science. Much remains to be done regarding the coagulation effects of the product [11]; pigs subjected to hemorrhagic shock and resuscitated with the investigational product had reduced maximal amplitudes when compared to control animals. Example of characteristics for the ideal resuscitation fluid No storage lesion for prolonged periods at ambient temperatures up to 130◦F (54◦C) Ready or prepared for use Universally compatible Support oxygen-carrying capacity Mitigates or negates post-shock, post-resuscitation syndromes Compatible with blood products No impairment of coagulation capability Minimal or mitigating effect on edema Improves microcirculation Enhance cellular resuscitation Support mitochondrial function Components fully eliminated from the body Suitable for administration by a wide range of medical personnel No behavioral or physical post-resuscitation impairment Maintain or restore normal species dependent values for: Electrolytes concentrations Osmolarity Tonicity Colloid osmotic pressure Viscosity Acid-Base homeostasis Caloric requirements
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