Current opinion in critical care
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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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Fluid therapy practices are an ongoing debate in critical care as evidence continues to emerge on the clinical effectiveness of different fluids and regimens. Although fluid therapy is a frequent and often costly treatment in the ICU, cost considerations have been largely absent from these studies. To facilitate a more structured approach to understanding fluid therapy costs and their role in clinical practice, we summarize currently available options and describe a framework for identifying and organizing relevant costs. ⋯ Given the growing emphasis on the value of care, providers must recognize the important cost consequences of clinical decisions in fluid therapy. Future research into fluid therapy costs is needed and can be guided by this framework. Developing a complete cost picture is an initial and necessary step for improving values for patients, hospitals, and healthcare systems.
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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.
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Curr Opin Crit Care · Aug 2014
ReviewIntravenous fluids in traumatic brain injury: what's the solution?
Intravenous fluid is a fundamental component of trauma care and fluid management influences patient outcomes. This narrative review appraises recent clinical studies of fluid therapy in patients with traumatic brain injury (TBI), with respect to its use in volume resuscitation and prevention of secondary injury. ⋯ In patients with TBI, intravenous fluids are integral to management; they may be both a source of harm and a potential therapy to limit secondary brain injury. They should be prescribed in accordance with other pharmaceutical or therapeutic interventions. Refined usage may improve patient outcomes.