Delayed-fluid resuscitation Yes/No ?

[Duchesne, Juan C]

-Are you a DFR-believer ? Why ?
            Ivan-

Yes. 

While hypotensive resuscitation is an integral part of the new strategy of DCR, the practice itself is not a new concept. Walter Cannon and John Fraser remarked on it as early as 1918 when serving with the Harvard Medical Unit in France during World War I. They made the following observations on patients undergoing fluid resuscitation: "Injection of a fluid that will increase blood pressure has dangers in itself. Hemorrhage in a case of shock may not have occurred to a marked degree because blood pressure has been too low and the flow to scant to overcome the obstacle offered by the clot. If the pressure is raised before the surgeon is ready to check any bleeding that may take place, blood that is sorely needed may be lost." Dr. Cannon's endpoint of resuscitation prior to definitive hemorrhage control was a systolic pressure of 70-80 mmHg, using a crystalloid/colloid mixture as his fluid of choice. Permissive hypotension (restricted fluid resuscitation) and reduction of crystalloid overload has been shown by the military in Iraq  to increase survival. Although this has not reached standard of care level, there is enough data to indicate the overly aggressive fluid crystalloid resuscitation is probably not good. Crystalloid use should be for maintenance use only.  In the ED, patients with suspected uncontrolled hemorrhage, resuscitation should be limited to plasma and blood with immediate surgical intervention. 

Juan

CharityOne


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From: trauma-list-bounces at trauma.org on behalf of Ivan Hronek
Sent: Tue 5/20/2008 10:58 PM
To: trauma-list at trauma.org
Subject: Delayed-fluid resuscitation Yes/No ?



Question: - is your center practicing the delayed fluid resuscitation in trauma victims ?
               - are you a DFR-believer ? Why ?
 Ivan Hronek MD                                                                             
SFMC, Los Angeles, CA                                                
http://health.groups.yahoo.com/group/Anesthideas/                           Do not fear to be eccentric in opinion, for every opinion now
accepted was once eccentric. - Bertrand Russell-
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