Delayed Fluid Resuscitation of Head Injury and Uncontrolled Hemorrhagic Shock

Open Access
Publisher Website
Google Scholar
Abstract
DATA FROM a recent clinical prospective randomized trial have suggested that prehospital fluid administration in hypotensive trauma patients reduces survival when compared with delayed resuscitation (DR).1 Confirmatory laboratory work has shown that aggressive fluid resuscitation of uncontrolled hemorrhage results in an increase in blood pressure and dilution of coagulation factors, leading to clot disruption at the site of bleeding and continued blood loss.2 Although these studies are interesting and have challenged conventional thinking about resuscitation of hemorrhagic shock, none has addressed the issue of concomitant head injury—the leading cause of traumatic death in the United States.3 When combined with severe head injury, hypotension doubles mortality by creating a secondary ischemic injury.4 Thus, aggressive resuscitation with rapid elevation of blood pressure has been advocated in patients with head injury.5 In fact, the recent guidelines for the management of head injury categorically state that "the concept of delayed resuscitation cannot be considered applicable in head injury."6 We undertook this investigation to study the effect of DR on cerebral hemodymanics in a model of simulated uncontrolled (pressure-driven) hemorrhage combined with cryogenic brain injury. We hypothesized that early (prehospital) fluid resuscitation would improve cerebral blood flow (CBF) and regional cerebral oxygen delivery (COD) compared with DR (operating room).

This publication has 1 reference indexed in Scilit: