Current opinion in critical care
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Fluid management is regarded as a cornerstone of successful perioperative care, but fluid prescription is not always treated that way. New insights and guidelines have become available very recently. ⋯ The combination of a careful prescription of maintenance fluids, additional replacement solutions tailored to the patient's eventual extra needs and a rational but nonaggressive goal-directed approach to resuscitation fluids seems to be the best practice to avoid fluid-related morbidity. Isotonic balanced crystalloids seem the best pragmatic choice for resuscitation purposes. In certain well defined conditions, colloids can still be used.
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The characteristics of an ideal intravenous fluid in the critically ill patient are discussed. ⋯ The ideal fluid currently does not exist. Of existing options, use of hydroxyethyl starches and high chloride-containing crystalloid solutions should be discouraged. There is a lack of direct evidence that a balanced crystalloid solution confers benefit, however, the trend of recent data would support future investigation into the advantage of balanced solution over 0.9% saline.
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Fluid resuscitation in trauma patients could reduce organ failure, until blood components are available and hemorrhage is controlled. However, the ideal fluid resuscitation strategy in trauma patients remains a debated topic. Different types of trauma can require different types of fluids and different volume of infusion. ⋯ In order to focus on the state of the art about this topic, we review the current literature and guidelines. Recent studies have underlined that the correct fluid resuscitation strategy can depend on the type of trauma condition: penetrating, blunt, brain injury or a combination of them. Of course, further studies are needed to investigate the impact of a specific fluid strategy on different type and severity of trauma.
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Curr Opin Crit Care · Aug 2014
ReviewPerioperative haemodynamic management: is echocardiography the right tool?
This review analyses the application of perioperative echocardiography as an important tool in the management of haemodynamic impairment. ⋯ Echocardiography has recently gained popularity among anaesthesiologists and intensive care practitioners because it provides a pathophysiological picture of haemodynamic impairment, allowing a more detailed understanding of the static or dynamic parameters on which clinicians usually rely when making decisions.
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Curr Opin Crit Care · Aug 2014
ReviewOptimal fluid resuscitation in trauma: type, timing, and total.
This review article explores the recent literature regarding the optimal type and amount of intravenous fluids for the trauma patient from the time of injury through their ICU stay. It discusses damage control principles as well as targeted resuscitation utilizing new technology. ⋯ During the resuscitation of the acutely injured patient, crystalloids should be limited in favor of blood components. Damage control principles apply until definitive hemostasis is obtained, at which point the focus should change to targeted resuscitation using traditional global endpoints of resuscitation in conjunction with determinants of regional perfusion.