New Developments in Fluid Resuscitation

An ideal fluid for the resuscitation of trauma victims should be safe; efficacious; cheap; easy to store and transport (especially important for the military); have the capacity to carry oxygen and nutrients to the cells; and protect the cells from resuscitation injury. Unfortunately, such a fluid is not available today. Because of the emerging data on fluid cytotoxicity, clinicians should consider resuscitation fluids as drugs, with well-defined indications and contraindication, safe dosages, and side effects. A logical approach is to prevent the onset of immune dysfunction, rather than try to control multiple interconnected cascades once they have been activated. Patient's response to trauma is influenced by a number of variables (comorbid problems, severity of injuries, degree of shock, delay in definitive care, and so forth). As compared with most of the other variables that cannot be altered, resuscitative strategy is entirely under clinicians' control. They choose the nature of the fluids, rate of administration, timing, and the end points of resuscitation. They also may decide not to resuscitate in selected patients.