The cellular metabolic and systemic consequences of aggressive fluid resuscitation strategy

Department of General Surgery, Vanderbilt University School of Medicine, Nashville, TN 37212, USA.
Shock (Impact Factor: 3.05). 09/2006; 26(2):115-21. DOI: 10.1097/01.shk.0000209564.84822.f2
Source: PubMed


Increasing evidence has demonstrated that aggressive crystalloid-based resuscitation strategies are associated with cardiac and pulmonary complications, gastrointestinal dysmotility, coagulation disturbances, and immunological and inflammatory mediator dysfunction. As large volumes of fluids are administered, imbalances in intracellular and extracellular osmolarity occur. Disturbances in cell volume disrupt numerous regulatory mechanisms responsible for keeping the inflammatory cascade under control. Several authors have demonstrated the detrimental effects of large, crystalloid-based resuscitation strategies on pulmonary complications in specific surgical populations. Additionally, fluid-restrictive strategies have been associated with a decreased frequency of and shorter time to recovery from acute respiratory distress syndrome and trends toward shorter lengths of stay and lower mortality. Early resuscitation of hemorrhagic shock with predominately saline-based regimens has been associated with cardiac dysfunction and lower cardiac output, as well as higher mortality. Numerous investigators have evaluated potential risk factors for developing abdominal compartment syndrome and have universally noted the excessive use of crystalloids as the primary determinant. Resuscitation regimens that cause early increases in blood flow and pressure may result in greater hemorrhage and mortality than those regimens that yield comparable flow and pressure increases late in resuscitation. Future resuscitation research is likely to focus on improvements in fluid composition and adjuncts to administration of large volume of fluid.

Download full-text


Available from: Bryan A Cotton, Sep 02, 2014

Click to see the full-text of:

Article: The cellular metabolic and systemic consequences of aggressive fluid resuscitation strategy

245.69 KB

See full-text
  • Source
    • "Hemodynamic derangements due to hypovolemic shock should be reversed as quickly as possible with volume resuscitation. However, over use of crystalloids can result in third spacing worsening bowel edema, anastomotic leaks, ACS and multi-organ failure [59,60]. Accordingly, the use of massive transfusion protocols (MTP) has been recommended for DCL patients [60-62]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Damage control laparotomy was first described by Dr. Harlan Stone in 1983 when he suggested that patients with severe trauma should have their primary procedures abbreviated when coagulopathy was encountered. He recommended temporizing patients with abdominal packing and temporary closure to allow restoration of normal physiology prior to returning to the operating room for definitive repair. The term damage control in the trauma setting was coined by Rotondo et al., in 1993. Studies in subsequent years have validated this technique by demonstrating decreased mortality and immediate post-operative complications. The indications for damage control laparotomy have evolved to encompass abdominal compartment syndrome, abdominal sepsis, vascular and acute care surgery cases. The perioperative critical care provided to these patients, including sedation, paralysis, nutrition, and fluid management strategies may improve closure rates and recovery. In the rare cases of inability to primarily close the abdomen, there are a number of reconstructive strategies that may be used in the acute and chronic phases of abdominal closure.
    World Journal of Emergency Surgery 12/2013; 8(1):53. DOI:10.1186/1749-7922-8-53 · 1.47 Impact Factor
  • Source
    • "Finally, in the late 1990s clinicians started realizing the deleterious effects of excess crystalloid [11,12]. This led to a return to the balanced resuscitation that was reminiscent of that described in the Second World War. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Traumatic injury is a common problem, with over five million worldwide deaths from trauma per year. An estimated 10 to 20% of these deaths are potentially preventable with better control of bleeding. Damage control resuscitation involves early delivery of plasma and platelets as a primary resuscitation approach to minimize trauma-induced coagulopathy. Plasma, red blood cell and platelet ratios of 1:1:1 appear to be the best substitution for fresh whole blood; however, the current literature consists only of survivor bias-prone observational studies.
    07/2013; 2(1). DOI:10.1186/2047-0525-2-13
  • Source
    • "Our findings, " data not shown, " have been shared by other authors [10] [13]. Fluidrestrictive strategies have been associated with a decreased frequency of and shorter time to recovery from acute respiratory distress syndrome and trends toward shorter lengths of stay and lower mortality [10] [13]. The proper control of liquids provides the ability to perform surgery earlier in patients with severe burns, thus accelerating heal- ing. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients who suffer from severe burns develop metabolic imbalances and systemic inflammatory response syndrome (SIRS) which can result in multiple organ failure and death. Research aimed at reducing the inflammatory process has yielded new insight into burn injury therapies. In this review, we discuss strategies used to curb inflammation in burn injuries and note that further studies with high quality evidence are necessary.
    05/2013; 2013:715645. DOI:10.1155/2013/715645
Show more