Fluid Resuscitation for Trauma Patients: Crystalloids Versus Colloids

Jabaley, Craig S.; Dudaryk, Roman

doi:10.1007/s40140-014-0067-4

Cited by 15 publications

(5 citation statements)

References 72 publications

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“…In addition to the surgical control of bleeding, fluid resuscitation remains one of the most important life-saving interventions. The use of colloids and crystalloids for resuscitation of bleeding patients has previously remained controversial with no definitive answer for the best course of action [ 1 – 4 ]. In trauma patients, hemorrhage has been proposed as the second most common contributing cause of death within 48 h following the injury [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Volume-replacement ratio for crystalloids and colloids during bleeding and resuscitation: an animal experiment

László

Demeter

Öveges

et al. 2017

ICMx

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BackgroundFluid resuscitation remains a cornerstone in the management of acute bleeding. According to Starling's “Three-compartment model”, four-times more crystalloids have the same volume effect as colloids. However, this volume-replacement ratio remains a controversial issue as it may be affected by the degradation of the endothelial glycocalyx layer, a situation often found in the critically ill. Our aim was to compare colloid and crystalloid based fluid resuscitation during an experimental stroke volume index (SVI) guided hemorrhage and resuscitation animal model.MethodsAnesthetized and mechanically ventilated pigs were randomized to receive a colloid (Voluven®,HES, n=15) or crystalloid (Ringerfundin®,RF, n=15) infusion. Animals were bled till baseline SVI (Tbsl) dropped by 50% (T0), followed by resuscitation until initial SVI was reached (T4) in four steps. Invasive hemodynamic measurements, blood gas analyses and laboratory tests were performed at each assessment points. Glycocalyx degradation markers (Syndecan-1/hematocrit ratio, Glypican/hematocrit ratio) were determined at Tbsl, T0 and T4.ResultsSimilar amounts of blood were shed in both groups (HES group: 506±159 mls blood, RF group: 470±127 mls blood). Hemodynamic changes followed the same pattern without significant difference between the groups. Animals received significantly less resuscitation fluid in the HES compared to the RF-group: 425 [320-665], vs 1390 [884-1585] mls, p <0.001. The volume replacement ratio was 0.92 [0.79-1.54] for HES; and 3.03 [2.00-4.23] for the RF-group (p <0.001). There was no significant difference between the groups in the glycocalyx degradation markers.ConclusionIn this moderate bleeding-resuscitation animal model the volume-replacement ratio for crystalloids and colloids followed similar patterns as predicted by Starling's principle, and the glycocalyx remained intact. This indicates that in acute bleeding events, such as trauma or during surgery, colloids may be beneficial as hemodynamic stability may be achieved more rapidly than with crystalloids.

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Section: Introductionmentioning

confidence: 99%

Volume-replacement ratio for crystalloids and colloids during bleeding and resuscitation: an animal experiment

László

Demeter

Öveges

et al. 2017

ICMx

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“…Although the volume of fluid between OMX and vehicle was matched, OMX is a PEGylated protein-containing product, and both protein and PEG have oncotic properties; thus, neither protein-nor PEGrelated oncotic pressures were controlled. In the absence of blood products, various methods to replace volume and increase oncotic pressure have been extensively evaluated, with no clear benefit to colloid over crystalloid replacement for shock resuscitation (49)(50)(51)(52). Second, although biochemical surrogates of oxygen delivery were measured, cardiac output was not directly determined during these studies, negating the ability to directly calculate vascular resistance.…”

Section: Discussionmentioning

confidence: 99%

Omx: A Novel Oxygen Delivery Biotherapeutic Improves Outcomes in an Ovine Model of Controlled Hemorrhagic Shock

Maltepe,

Smith,

Boehme

et al. 2024

Shock

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Hemorrhagic shock is a major source of morbidity and mortality worldwide. While whole blood or blood product transfusion is a first line treatment, maintaining robust supplies presents significant logistical challenges, particularly in autere environments. OMX is a novel non-hemoglobin (Hb)-based oxygen carrier derived from the H-NOX (Heme-Nitric Oxide/Oxygen binding) protein family. Due to their engineered oxygen (O2) affinities, OMX proteins only deliver O2 to severely hypoxic tissues. Additionally, unlike Hb-based oxygen carriers, OMX proteins do not scavenge nitric oxide in the vasculature. To determine the safety and efficacy of OMX in supporting tissue oxygen delivery and cardiovascular function in a large-animal model of controlled hemorrhage, 2-3-week-old lambs were anesthetized, intubated, and mechanically ventilated. Hypovolemic shock was induced by acute hemorrhage to obtain a 50% reduction over 30 minutes. Vehicle (n = 16) or 400 mg/kg OMX (n = 13) treatment was administered over 15 minutes. Hemodynamics, arterial blood gases, and laboratory values were monitored throughout the 6 hour study. Comparisons between groups were made using T tests, Wilcoxon Rank Sum test, and Fisher’s Exact test. Survival was assessed using Kaplan Meier curves and the Log-Rank test. We found that OMX was well-tolerated and significantly improved lactate and base deficit trends, and hemodynamic indices (p < 0.05). Median survival time was greater in the OMX-treated group (4.7 vs. 6.0 hr., p < 0.003), and overall survival was significantly increased in the OMX-treated group (25% vs. 85%, p = 0.004). We conclude that OMX is well-tolerated and improves metabolic, hemodynamic and survival outcomes in an ovine model of controlled hemorrhagic shock.

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“…Возмож-на положительная роль небольших объемов ГЭК в ранней реанимации при проникающих ранениях, особенно при задержке транспортировки в про-фильный стационар. Недостаточно доказательств, чтобы рекомендовать ГЭК в условиях стационара во время начальной реанимации, интраоперационно или в отделении интенсивной терапии (ОИТ), осо-бенно в связи с установленным плохим профилем безопасности у критических больных [8].…”

Section: научный обзор / Scientific Reviewunclassified

Якісна Клінічна Практика Стартової Інтенсивної Терапії При Бойовій І Цивільній Політравмі (Огляд Літератури)

Йовенко¹,

Kobelyatskyу²,

Tsarev³

et al. 2022

ЕМ

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Fluid Resuscitation for Trauma Patients: Crystalloids Versus Colloids

Cited by 15 publications

References 72 publications

Volume-replacement ratio for crystalloids and colloids during bleeding and resuscitation: an animal experiment

Volume-replacement ratio for crystalloids and colloids during bleeding and resuscitation: an animal experiment

Omx: A Novel Oxygen Delivery Biotherapeutic Improves Outcomes in an Ovine Model of Controlled Hemorrhagic Shock

Якісна Клінічна Практика Стартової Інтенсивної Терапії При Бойовій І Цивільній Політравмі (Огляд Літератури)

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