Fluid therapy in trauma resuscitation : A review of changing practices.
Background: Haemorrhage is the leading preventable cause of post trauma death. Acute trauma resuscitation has evolved over the last decade. The ATLS guidance used since 2012 is being updated in 2018.
Objectives : To search relevant representative literature over 6 years between 2012 and 2018 to gain an insight into changing concepts, practices and recent advances in acute trauma fluid resuscitation and provide a structured review of the topic.
Search methods: A relevant MEDLINE search was undertaken to obtain a list of 1512 articles from which 107 were utilised to prepare this review.
Selection criteria:1. Inclusion: Articles from human medicine relevant to fluid resuscitation in trauma published in English between January 2012 and January 2018. 2.
Exclusion: Articles restricted to Brain, spinal trauma or cardiovascular trauma, post traumatic arrest patients, animal or human laboratory model studies and articles on septic, postoperative, obstetric patients and single case studies were excluded.
Results: This review categorises the topic into various parts to explain the evolving understanding of fluid resuscitation, trauma induced coagulopathy and endotheliopathy of trauma. The strategies for acute fluid management like damage-controlled resuscitation, balanced and haemostatic resuscitation and massive transfusion protocol are explained. A detailed discussion is carried out regarding crystalloid, colloid and blood transfusion. Special consideration is given to specific age groups, combat casualties and prehospital trauma care.
Conclusions: Fluid resuscitation in trauma is a complex and rapidly evolving subject. Massive transfusion protocols and principles of damage control are significant for patient outcome. Standard guidance like ATLS is relevant and important for training professionals to deliver systematic, high quality of trauma care. There is scope for local improvisation based on resources and need for more high-quality trials and frequent systematic reviews.
Bangladesh Crit Care J March 2018; 6(1): 31-39
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