Synthetic colloid resuscitation in severely injured patients: analysis of a nationwide trauma registry (TraumaRegister DGU)

Hilbert-Carius, Peter; Schwarzkopf, Daniel; Reinhart, Konrad; Hartog, Christiane S.; Lefering, Rolf; Bernhard, Michaël; Struck, Matthias

doi:10.1038/s41598-018-30053-0

Cited by 16 publications

(9 citation statements)

References 36 publications

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“…Ein kürzlich erschienener Wissenschaftsreport aus dem deutschen Traumaregister wirft allerdings auch für die bis dato als sicher erachtete Indikation der HES-Gabe bei hypovolämischem Schock neue Fragen auf [ 41 ]. Die Autoren konnten nach einer Analyse von über 48.000 Patienten zwischen 2002 und 2015 einen Zusammenhang zwischen der Therapie mit >1000 ml an synthetischen Kolloiden und einer erhöhten Rate an Nierenersatzverfahren sowie Multiorganversagen feststellen.…”

Section: Perioperatives Flüssigkeitsmanagementunclassified

Perioperatives Flüssigkeitsmanagement bei großen viszeralchirurgischen Eingriffen

et al. 2020

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Zusammenfassung Die Gabe intravasaler Flüssigkeiten gehört zu den Grundpfeilern der perioperativen Therapie und nimmt insbesondere bei großen viszeralchirurgischen Eingriffen maßgeblichen Einfluss auf das chirurgische Behandlungsergebnis. Ein adäquates perioperatives Flüssigkeitsmanagement kann durch Vermeidung von Hypo- und Hypervolämie dazu beitragen, das Risiko einer unzureichenden Gewebeperfusion als Treiber postoperativer Morbidität und Letalität signifikant zu reduzieren. Der effektive Umgang mit intravasal zugeführten Flüssigkeiten setzt dabei die Kenntnis der Substanzen sowie Maßnahmen zur Therapiesteuerung voraus. Das Flüssigkeitsmanagement beginnt bereits präoperativ und sollte – unter Nutzung einer an die Bedürfnisse des Patienten angepassten und dem Eingriff entsprechenden hämodynamischen Überwachung – auch postoperativ im Aufwachraum und auf Station fortgesetzt werden. Der Kommunikation aller an der perioperativen Versorgung Beteiligten kommt im Sinne eines optimalen Flüssigkeitsmanagements eine entscheidende Bedeutung zu.

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Section: Perioperatives Flüssigkeitsmanagementunclassified

Perioperatives Flüssigkeitsmanagement bei großen viszeralchirurgischen Eingriffen

et al. 2020

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“…Excessive crystalloid has also been implicated in the development of late complications including abdominal compartment syndrome and MODS 1 . Colloid fluids including gelatin and starch‐based products have been associated with an increased risk of coagulopathy and renal injury and their use has largely been abandoned 14 . Our data shows a change in practice towards haemostatic resuscitation principles, which include using restraint with pre‐hospital and emergency department crystalloid, abandonment of colloid fluids, and increasing plasma and cryoprecipitate to achieve close to a 1:1 ratio of red blood cells to plasma, where previously it had been a 3:1 ratio.…”

Section: Discussionmentioning

confidence: 99%

Haemorrhagic death from severe liver trauma has decreased in the era of haemostatic resuscitation

Fischer

Civil

2021

ANZ Journal of Surgery

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Background Severe liver trauma can cause major haemorrhage and death. Haemostatic resuscitation principles are associated with improved survival in trauma patients with major haemorrhage. We hypothesised death from liver haemorrhage decreased in parallel with the introduction of haemostatic resuscitation. Aim To establish the incidence of haemorrhagic death in patients with severe liver trauma and review how outcomes in two time periods associate with changes in resuscitation practice. Methods A retrospective review of all adult patients admitted to Auckland City Hospital with liver trauma was undertaken for a 14‐year period. Resuscitation fluid for patients with grade V liver trauma or death from liver haemorrhage was compared between the first and second half of the study (2006–2013 vs. 2013–2020). Results Four hundred and fifty patients were admitted with liver trauma during the 14‐year period. Mortality from haemorrhage in patients with severe liver trauma (grade IV and V) decreased between the first and second half of the study (p = 0.009). Pre‐hospital and emergency department crystalloid fluid use decreased (p = 0.002). Fresh frozen plasma in ED (p = 0.076) and total cryoprecipitate use (p = 0.072) increased. Tranexamic acid use increased (p = 0.002). Use of colloid fluid was abandoned (p = 0.013). There was no significant difference in pre‐hospital time or time from hospital arrival until haemorrhage control laparotomy. Conclusion Death from liver haemorrhage decreased in association with the introduction of haemostatic resuscitation while the incidence, severity and surgical management of liver trauma was comparable.

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“…Using colloid resuscitation in femoral fracture group and severe trauma patients has a worsening prognosis. A study 19 investigated the safety and efficacy of synthetic colloid resuscitation among severely trauma patients. This study suggests that synthetic colloid resuscitation provide no beneficial effects and will be harmful in patients who are severe trauma.…”

Section: Discussionmentioning

confidence: 99%

Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran

Paydar

Akerdi

Nikseresht

et al. 2021

Chinese Journal of Traumatology

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Purpose Traumatic hemorrhagic shock is a life-threatening event worldwide. Severe brain trauma accompanying femoral fractures can trigger inflammatory responses in the body and increase pre-inflammatory cytokines such as TNF-α, IL-1. The primary treatment in these cases is hydration with crystalloids, which has both benefits and complications. The purpose of this study was to investigate the effects of fluid therapy on the hemodynamics, coagulation profiles, and blood gases in such patients. Methods In this cross-sectional study, patients were divided into two groups: femoral fracture group and non-femoral group. The hemodynamic status, coagulation profile, and blood gases of patients in both groups were evaluated upon arrival at the hospital and again 2 h later. Data were analyzed by t -test and ANOVA with repeated data and paired samples t -test. Results A total of 681 trauma patients (605 men and 76 women) participated in this study, including 69 (86.3%) men and 11 (13.8%) women in femoral fracture group and 536 men (89.2%) and 65 women (10.8%) in non-femoral group. The laboratory parameters were evaluated in response to the equal amount of crystalloid fluid given upon arrival and 2 h later. Blood gases decreased in the fracture group despite fluid therapy ( p < 0.003), and the coagulation profile worsened although the change was not statistically significant. Conclusion The treatment of multiple-trauma patients with femoral bone fractures should be more concerned with the need for the infusion of vasopressors such as norepinephrine. If there is evidence of clinical shock, excessive crystalloid infusion (limited to 1 L) should be avoided, and blood and blood products should be started as soon as possible.

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Synthetic colloid resuscitation in severely injured patients: analysis of a nationwide trauma registry (TraumaRegister DGU)

Cited by 16 publications

References 36 publications

Perioperatives Flüssigkeitsmanagement bei großen viszeralchirurgischen Eingriffen

Perioperatives Flüssigkeitsmanagement bei großen viszeralchirurgischen Eingriffen

Haemorrhagic death from severe liver trauma has decreased in the era of haemostatic resuscitation

Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran

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