Intravenous fluid resuscitation for the trauma patient

Abstract

Although longstanding practice in trauma care has been to provide immediate, aggressive intravenous fluid resuscitation to injured patients with presumed internal hemorrhage, recent experimental and clinical data suggest a more discriminating approach that first considers concurrent head injury, hemodynamic stability, and the presence of potentially uncontrollable hemorrhage (e.g., deep truncal injury) versus a controllable source (e.g., distal extremity wound). The data suggest that rapid intravenous fluid infusions could be used for patients with isolated extremity, thermal or head injury. However, intravenous fluids should be limited in conditions with potentially uncontrollable internal hemorrhage, and particularly in patients with penetrating truncal injury being transported immediately to a trauma center. Likewise, positive pressure ventilatory support should be limited with severe hemorrhage due to the secondary reductions in venous return off-setting the effects of the fluids. For trauma patients with severe bleeding, there is growing evidence for the increased use of plasma and factor VIIa, as well as tourniquets, intra-osseus devices, and evolving monitoring techniques. Future research efforts in trauma should focus on the timing and rate of infusions as well as the concept of infusing alternative intravenous resuscitative fluids such as hemoglobin-based oxygen carriers (HBOCs) and the use of hemostatic agents and special blood products.