<< Traumatic Hemorrhagic Shock: Advances In Fluid Management (Trauma CME)


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Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study, will be included in bold type following the reference, where available. In addition, the most informative references cited in this paper, as determined by the author, will be noted by an asterisk (*) next to the number of the reference.

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  7. Shires T, Coln D, Carrico J, et al. Fluid therapy in hemorrhagic shock. Arch Surg. 1964;88:688-693. (Animal study)
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  10. Cotton BA, Guy JS, Morris JA, Jr, et al. The cellular, metabolic, and systemic consequences of aggressive fluid resuscitation strategies. Shock. 2006;26(2):115-121. (Guideline)
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  12. Shah KJ, Chiu WC, Scalea TM, et al. Detrimental effects of rapid fluid resuscitation on hepatocellular function and survival after hemorrhagic shock. Shock. 2002;18(3):242-247. (Animal study)
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  14. Pope AM, Institute of Medicine (U.S.). Fluid resuscitation: state of the science for treating combat casualties and civilian injuries. Washington, D.C.: National Academy Press; 1999. (IOM report/review)
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    180 patients
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  29. Guly HR, Bouamra O, Spiers M, et al. Vital signs and estimated blood loss in patients with major trauma: testing the validity of the ATLS classification of hypovolaemic shock. Resuscitation. 2011;82(5):556-559.
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  35. Shires GT, Browder LK, Steljes TP, et al. The effect of shock resuscitation fluids on apoptosis. Am J Surg. 2005;189(1):85-91. (Animal study)
  36. Ayuste EC, Chen H, Koustova E, et al. Hepatic and pulmonary apoptosis after hemorrhagic shock in swine can be reduced through modifications of conventional Ringer’s solution. J Trauma. 2006;60(1):52-63. (Animal study)
  37. Santry HP, Alam HB. Fluid resuscitation: past, present, and the future. Shock. 2010;33(3):229-241. (Review)
  38. Rizoli SB, Kapus A, Fan J, et al. Immunomodulatory effects of hypertonic resuscitation on the development of lung inflammation following hemorrhagic shock. J Immunol. 1998;161(11):6288-6296. (Review)
  39. Alam HB, Sun L, Ruff P, et al. E- and P-selectin expression depends on the resuscitation fluid used in hemorrhaged rats. J Surg Res. 2000;94(2):145-152. (Animal study)
  40. Todd SR, Malinoski D, Muller PJ, et al. Lactated Ringer’s is superior to normal saline in the resuscitation of uncontrolled hemorrhagic shock. J Trauma. 2007;62(3):636-639. (Animal study)
  41. Rizoli SB. Crystalloids and colloids in trauma resuscitation: a brief overview of the current debate. J Trauma. 2003;54(5 Suppl):S82-S88. (Review)
  42. Schierhout G, Roberts I. Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomised trials. BMJ. 1998;316(7136):961-964. (Review)
  43. Choi PT, Yip G, Quinonez LG, et al. Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med. 1999;27(1):200-210. (Systematic review)
  44. * Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350(22):2247-2256. (Prospective randomized double-blind; 6997 patients)
  45. Devlin JW, Barletta JF. Albumin for fluid resuscitation: implications of the Saline versus Albumin Fluid Evaluation. Am J Health Syst Pharm. 2005;62(6):637-642. (Commentary)
  46. Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2007(4):CD000567. (Systematic review)
  47. Myburgh J, Cooper DJ, Finfer S, et al. Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med. 2007;357(9):874-884. (Prospective randomized double-blind; 460 patients)
  48. Jacob M, Chappell D. Saline or albumin for fluid resuscitation in traumatic brain injury. N Engl J Med. 2007;357(25):2634-2635; author reply 2635-2636. (Commentary)
  49. Bunn F, Trivedi D, Ashraf S. Colloid solutions for fluid resuscitation. Cochrane Database Syst Rev. 2008(1):CD001319. (Systematic review)
  50. Velasco IT, Pontieri V, Rocha e Silva M Jr, et al. Hyperosmotic NaCl and severe hemorrhagic shock. Am J Physiol. 1980;239(5):H664-673. (Animal study)
  51. Junger WG, Coimbra R, Liu FC, et al. Hypertonic saline resuscitation: a tool to modulate immune function in trauma patients? Shock. 1997;8(4):235-241. (Review)
  52. Ciesla DJ, Moore EE, Gonzalez RJ, et al. Hypertonic saline inhibits neutrophil (PMN) priming via attenuation of p38 MAPK signaling. Shock. 2000;14(3):265-269; discussion 269-270. (Cell study)
  53. Ciesla DJ, Moore EE, Zallen G, et al. Hypertonic saline attenuation of polymorphonuclear neutrophil cytotoxicity: timing is everything. J Trauma. 2000;48(3):388-395. (Cell study)
  54. Bunn F, Roberts I, Tasker R, et al. Hypertonic versus near isotonic crystalloid for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2004(3):CD002045. (Systematic
  55. Cooper DJ, Myles PS, McDermott FT, et al. Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA. 2004;291(11):1350-1357. (Prospective randomized double-blind; 229 patients)
  56. Kramer GC, Perron PR, Lindsey DC, et al. Small-volume resuscitation with hypertonic saline dextran solution. Surgery. 1986;100(2):239-247. (Animal study)
  57. Maningas PA, Bellamy RF. Hypertonic sodium chloride solutions for the prehospital management of traumatic hemorrhagic shock: a possible improvement in the standard of care? Ann Emerg Med. 1986;15(12):1411-1414. (Review)
  58. Wade CE, Kramer GC, Grady JJ, et al. Efficacy of hypertonic 7.5% saline and 6% dextran-70 in treating trauma: a meta-analysis of controlled clinical studies. Surgery. 1997;122(3):609-616. (Meta-analysis)
  59. Rizoli SB, Rhind SG, Shek PN, et al. The immunomodulatory effects of hypertonic saline resuscitation in patients sustaining traumatic hemorrhagic shock: a randomized, controlled, double-blinded trial. Ann Surg. 2006;243(1):47-57. (Prospective randomized double-blind; 27 patients)
  60. Riddez L, Drobin D, Sjostrand F, et al. Lower dose of hypertonic saline dextran reduces the risk of lethal rebleeding in uncontrolled hemorrhage. Shock. 2002;17(5):377-382. (Animal
  61. Bruttig SP, O’Benar JD, Wade CE, et al. Benefit of slow infusion of hypertonic saline/dextran in swine with uncontrolled aortotomy hemorrhage. Shock. 2005;24(1):92-96. (Animal study)
  62. * Bulger EM, May S, Kerby JD, et al. Out-of-hospital hypertonic resuscitation after traumatic hypovolemic shock: a randomized, placebo controlled trial. Ann Surg. 2011;253(3):431-441. (Prospective randomized double-blind; 853 patients)
  63. Baker AJ, Rhind SG, Morrison LJ, et al. Resuscitation with hypertonic saline-dextran reduces serum biomarker levels and correlates with outcome in severe traumatic brain injury patients. J Neurotrauma. 2009;26(8):1227-1240.
  64. * Bulger EM, May S, Brasel KJ, et al. Out-of-hospital hypertonic resuscitation following severe traumatic brain injury: a randomized controlled trial. JAMA. 2010;304(13):1455-1464.(Prospective randomized double-blind; 1331 patients)
  65. Wiggers HC, Goldberg H, Roemhild F, et al. Impending hemorrhagic shock and the course of events following administration of dibenamine. Circulation. 1950;2(2):179-185. (Animal study)
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    randomized, 184 patients
  67. Sakles JC, Sena MJ, Knight DA, et al. Effect of immediate fluid resuscitation on the rate, volume, and duration of pulmonary vascular hemorrhage in a sheep model of penetrating thoracic trauma. Ann Emerg Med. 1997;29(3):392-399. (Animal study)
  68. Holmes JF, Sakles JC, Lewis G, et al. Effects of delaying fluid resuscitation on an injury to the systemic arterial vasculature. Acad Emerg Med. 2002;9(4):267-274. (Animal study)
  69. Stern SA, Dronen SC, Birrer P, et al. Effect of blood pressure on hemorrhage volume and survival in a near-fatal hemorrhage model incorporating a vascular injury. Ann Emerg Med. 1993;22(2):155-163. (Animal study)
  70. Stern SA, Kowalenko T, Younger J, et al. Comparison of the effects of bolus vs. slow infusion of 7.5% NaCl/6% dextran-70 in a model of near-lethal uncontrolled hemorrhage. Shock. 2000;14(6):616-622. (Animal study)
  71. Kowalenko T, Stern S, Dronen S, et al. Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic shock in a swine model. J Trauma. 1992;33(3):349-353; discussion
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  74. Revell M, Greaves I, Porter K. Endpoints for fluid resuscitation in hemorrhagic shock. J Trauma. 2003;54(5 Suppl):S63-S67. (Review)
  75. Blair SD, Janvrin SB, McCollum CN, et al. Effect of early blood transfusion on gastrointestinal haemorrhage. Br J Surg. 1986;73(10):783-785. (Prospective; 50 patients)
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  77. Barbee RW, Reynolds PS, Ward KR. Assessing shock resuscitation strategies by oxygen debt repayment. Shock. 2010;33(2):113-122. (Review)
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  80. Sondeen JL, Coppes VG, Holcomb JB. Blood pressure at which rebleeding occurs after resuscitation in swine with aortic injury. J Trauma. 2003;54(5 Suppl):S110-S117. (Animal study)
  81. Brandstrup B, Tonnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003;238(5):641-648. (Prospective randomized observerblinded; 172 patients)
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  108. Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010;376(9734):23-32. (Prospective randomized doubleblind; 20,211 patients)
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  111. Yu HP, Chaudry IH. The role of estrogen and receptor agonists in maintaining organ function after trauma-hemorrhage. Shock. 2009;31(3):227-237. (Review)
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  117. Gonzales E, Chen H, Munuve R, et al. Valproic acid prevents hemorrhage-associated lethality and affects the acetylation pattern of cardiac histones. Shock. 2006;25(4):395-401. (Animal
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November 2, 2011

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