Skip to main content
SpringerLink
Log in

RETRACTED ARTICLE: Fluid choice for resuscitation of the trauma patient: a review of the physiological, pharmacological, and clinical evidence

RETRACTED ARTICLE: Le choix du liquide pour la réanimation du patient polytraumatisé : une revue des données physiologiques, pharmacologiques et cliniques

  • Neuroanesthesia and Intensive Care
  • Published:
Canadian Journal of Anesthesia/Journal canadien d'anesthésie Aims and scope Submit manuscript

This article was retracted on 17 November 2021

This article has been updated

Abstract

Purpose

Volume replacement regimens are discussed very emotionally. Interpretation of the literature is difficult due to variations in study design, patient population, target for volume replacement, endpoints, and type of fluids. Meta-analyses may not be very helpful because all kinds of patients and very old studies are included. The principles and options for volume replacement were reviewed exclusively in trauma patients and studies from the literature focusing on this problem were analyzed.

Source

Using a MEDLINE search, volume replacement therapy in adult trauma patients published in the English language from 1985 to the end of 2002 were identified and analyzed. Studies on prehospital volume replacement, volume replacement in the emergency area or in the operating room, and volume therapy in trauma intensive care unit patients were included.

Principle findings

The age-old crystalloid/colloid controvery has still not been resolved but has been enlarged to a colloid/colloid debate. It is now widely accepted that human albumin could easily be replaced by synthetic colloids for volume replacement in trauma patients. No superiority of a specific volume replacement strategy with regard to outcome was found. However, in several studies outcome was not the major endpoint. Although showing some promising results, the importance of hypertonic solutions for volume replacement in the trauma patient is not yet defined.

Conclusion

The choice of fluid therapy in trauma patients engenders the most controversy and an examination of the body of literature on this subject results in confusion. It is imperative to continue the search for substances that are effective in avoiding the development of post-trauma multi-organ dysfunction syndrome without detrimental side-effects.

Résumé

Objectif

Les doses de remplissage vasculaire suscitent des discussions très émotives. L’interprétation des publications est difficile à cause de la diversité des devis d’études, des populations de patients, des cibles de remplissage vasculaire, des paramètres étudiés et des types de liquides. Les méta- analyses ne sont peut- être pas très utiles parce qu’elles comprennent tous les types de patients et d’anciennes études. Les principes qui régissent le remplissage vasculaire et les options offertes ont été revus exclusivement chez les polytraumatisés et les études qui mettent l’accent sur ce problème ont été analysées.

Source

Les articles sur le remplissage vasculaire réalisé chez les patients polytraumatisés et rapportés en anglais entre 1985 et la fin de 2002 ont été repérés dans MEDLINE et analysés. Les études sur le remplissage vasculaire préhospitalier, sur le remplissage vasculaire à l’urgence ou en salle d’opération et sur le remplissage vasculaire chez les patients polytraumatisés de l’unité des soins intensifs ont été retenues.

Constatations principales

La sempiternelle controverse cristalloïde/colloïde n’est pas encore résolue, et s’est étendue au débat colloïde/colloïde. On accepte généralement de remplacer l’albumine humaine par des colloïdes synthétiques chez les polytraumatisés. Nous n’avons trouvé aucune stratégie de remplissage vasculaire qui soit supérieure aux autres quant au résultat. De toute manière, le résultat n’était pas toujours le paramètre principal. Même si les solutions hypertoniques ont présenté quelques résultats prometteurs, leur importance dans le remplissage vasculaire chez les polytraumatisés n’est pas encore définie.

Conclusion

Le choix d’une fuidothérapie chez les polytraumatisés engendre la plus grande controverse. L’examen des publications sur le sujet n’apporte que confusion. Il faut poursuivre la recherche de substances efficaces, qui n’occasionnent pas de déficiences polyviscérales post- traumatiques et qui soient sans effets secondaires nocifs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Change history

References

  1. MacKenzie EJ, Morris JA Jr, Smith GS, Fahey M. Acute hospital costs of trauma in the United States: implica- tions for regionalized systems of care. J Trauma 1990; 30: 1096–103.

    CAS  PubMed  Google Scholar 

  2. Deane SA, Gaudry PL, Woods P, et al. The managment of injuries — a review of deaths in hospital. Aust N Z J Surg 1988; 58: 463–9.

    CAS  PubMed  Google Scholar 

  3. Deakin CD. Early fluid resuscitation in haemorrhagic shock. Eur J Emerg Med 1994; 1: 83–5.

    CAS  PubMed  Google Scholar 

  4. Bickell WH. Are victims of injury sometimes victimized by attempts at fluid resuscitation? Ann Emerg Med 1993; 22: 225–6.

    CAS  PubMed  Google Scholar 

  5. Lucas CE. Update on trauma in Canada. 4. Resuscitation through the three phases of hemorrhagic shock after trauma. Can J Surg 1990; 33: 451–6.

    CAS  PubMed  Google Scholar 

  6. Vane JR, Anggard EE, Botting RM. Regulatory functions of the vascular endothelium. N Engl J Med 1990; 323: 27–36.

    CAS  PubMed  Google Scholar 

  7. Hebert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, and the Canadian Critical Care Trials Group. N Engl J Med 1999; 340: 409–17.

    CAS  PubMed  Google Scholar 

  8. Landers DF, Hill GE, Wong KC, Fox LJ. Blood transfu- sion-induced immunomodulation. Anesth Analg 1996; 82: 187–204.

    CAS  PubMed  Google Scholar 

  9. Agarwal N, Murphy JG, Cayten CG, Stahl WM. Blood transfusion increases the risk of infection after trauma. Arch Surg 1993; 128: 171–7.

    CAS  PubMed  Google Scholar 

  10. Vaupshas HJ, Levy M. Distribution of saline following acute volume loading: postural effects. Clin Invest Med 1990; 13: 165–77.

    CAS  PubMed  Google Scholar 

  11. Funk W, Baldinger V. Microcirculatory perfusion during volume therapy. A comparative study using crystalloid or colloid in awake animals. Anesthesiology 1995; 82: 975–82.

    CAS  PubMed  Google Scholar 

  12. Prien T, Backhaus N, Pelster F, Pircher W, Bunte H, Lawin P. Effect of intraoperative fluid administration and colloid osmotic pressure on the formation of intestinal edema during gastrointestinal surgery. J Clin Anesth 1990; 2: 317–23.

    CAS  PubMed  Google Scholar 

  13. Schott U, Lindbom LO, Sjostrand U. Hemodynamic effects of colloid concentration in experimental hemorrhage: a comparison of Ringer’s acetate, 3% dextran-60 and 6% dextran-70. Crit Care Med 1988; 16: 346–52.

    CAS  PubMed  Google Scholar 

  14. Margarson MP, Soni N. Serum albumin: touchstone or totem? Anaesthesia 1998; 53: 789–803.

    CAS  PubMed  Google Scholar 

  15. Qiao R, Siflinger-Birnboim A, Lum H, Tiruppathi C, Malik AB. Albumin and ricinus communis agglutinin decrease endothelial permeability via interactions with matrix. Am J Physiol 1993; 265(2 Pt 1): C439–46.

    CAS  PubMed  Google Scholar 

  16. Kreimeier U, Peter K. Strategies of volume therapy in sepsis and systemic inflammatory response syndrome. Kidney Int Suppl 1998; 64: S75–9.

    CAS  PubMed  Google Scholar 

  17. Nearman HS, Herman ML. Toxic effects of colloids in the intensive care unit. Crit Care Clin 1991; 7: 713–23.

    CAS  PubMed  Google Scholar 

  18. Peano S, Reiner G, Carbonatto M, Bodenbender L, Boland P, Abel KJ. Determination of the clearance factor for transmissible spongiform encephalopathy agents during the manufacturing process of polygeline. Intensive Care Med 2000; 26: 608–12.

    CAS  PubMed  Google Scholar 

  19. Paull J. A prospective study of dextran-induced anaphylactoid reactions in 5745 patients. Anaesth Intensive Care 1987; 15: 163–7.

    CAS  PubMed  Google Scholar 

  20. Laxenaire MC, Charpentier C, Feldman L. Anaphylactoid reactions to colloid plasma substitutes: incidence, risk factors, mechanisms. A French multicenter prospective study (French). Ann Fr Anesth Reanim 1994; 13: 301–10.

    CAS  PubMed  Google Scholar 

  21. Ruttmann TG, James MF, Aronson I. In vivo investigation into the effects of haemodilution with hydroxyethyl starch (200/0.5) and normal saline on coagulation. Br J Anaesth 1998; 80: 612–6.

    CAS  PubMed  Google Scholar 

  22. Joorgensen KA, Stoffersen E. Heparin like activity of albumin. Thromb Res 1979; 16: 69–74.

    Google Scholar 

  23. Strauss RG. Volume replacement and coagulation: a comparative review. J Cardiothorac Anesth 1988; 2(suppl 1): 24–32.

    Google Scholar 

  24. de Jonge E, Levi M, Berends F, van der Ende AE, ten Cate JW, Stoutenbeek CP. Impaired haemostasis by intravenous administration of a gelatin-based plasma expander in human subjects. Thromb Haemost 1998; 79: 286–90.

    PubMed  Google Scholar 

  25. Warren BB, Durieux ME. Hydroxyethyl starch: safe or not? Anesth Analg 1997; 84: 206–12.

    CAS  PubMed  Google Scholar 

  26. Treib J, Haass A, Pindur G, Grauer MF, Wenzel E, Schimrigk K. All medium starches are not the same: influence of the degree of hydroxyethyl substitution of hydroxyethyl starch on plasma volume, hemorrheologic conditions, and coagulation. Transfusion 1996; 36: 450–5.

    CAS  PubMed  Google Scholar 

  27. de Jonge E, Levi M. Effects of different plasma substi- tutes on blood coagulation: a comparative review. Crit Care Med 2001; 29: 1261–7.

    PubMed  Google Scholar 

  28. Boldt J, Muller M, Heesen M, Heyn O, Hempelmann G. Influence of different volume therapies on platelet function in the critically ill. Intensive Care Med 1996; 22: 1075–81.

    CAS  PubMed  Google Scholar 

  29. Morisaki H, Bloos F, Keys J, Martin C, Neal A, Sibbald WJ. Compared with crystalloid, colloid therapy slows progression of extrapulmonary tissue injury in septic sheep. J Appl Physiol 1994; 77: 1507–18.

    CAS  PubMed  Google Scholar 

  30. Weil MH, Henning RJ, Puri VK. Colloid oncotic pressure: clinical significance. Crit Care Med 1979; 7: 113–26.

    CAS  PubMed  Google Scholar 

  31. Fleck A, Raines G, Hawker F, et al. Increased vascular permeability: a major cause of hypoalbuminaemia in disease and injury. Lancet 1985; 1: 781–4.

    CAS  PubMed  Google Scholar 

  32. Rackow EC, Mecher C, Astiz ME, Griffel M, Falk JL, Weil MH. Effects of pentastarch and albumin infusion on cardiorespiratory function and coagulation in patients with severe sepsis and systemic hypoperfusion. Crit Care Med 1989; 17: 394–8.

    CAS  PubMed  Google Scholar 

  33. Vincent JL. Plugging the leaks? New insights into synthetic colloids. Crit Care Med 1991; 19: 316–8.

    CAS  PubMed  Google Scholar 

  34. Gosling P, Sanghera K, Dickson G. Generalized vascular permeability and pulmonary function in patients following serious trauma. J Trauma 1994; 36: 477–81.

    CAS  PubMed  Google Scholar 

  35. Rozich JD, Paul RV. Acute renal failure precipitated by elevated colloid osmotic pressure. Am J Med 1989; 87: 359–60.

    CAS  PubMed  Google Scholar 

  36. Koppel C, Baudisch H, Ibe K. Inadvertent metal load- ing of critically ill patients with acute renal failure by human albumin solution infusion therapy. J Toxicol Clin Toxicol 1988; 26: 337–56.

    CAS  PubMed  Google Scholar 

  37. Legendre C, Thervet E, Page B, Percheron A, Noel LH, Kreis H. Hydroxyethylstarch and osmotic-nephrosis- like lesions in kidney transplantation. Lancet 1993; 342: 248–9.

    CAS  PubMed  Google Scholar 

  38. Cittanova ML, Leblanc I, Legendre C, Mouquet C, Riou B, Coriat P. Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients. Lancet 1996; 348: 1620–2.

    CAS  PubMed  Google Scholar 

  39. Schortgen F, Lacherade JC, Bruneel F, et al. Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study. Lancet 2001; 357: 911–6.

    CAS  PubMed  Google Scholar 

  40. Boldt J, Müller M, Mentges D, Papsdorf M, Hempelmann G. Volume therapy in the critically ill: is there a difference? Intensive Care Med 1998; 24: 28–36.

    CAS  PubMed  Google Scholar 

  41. Kumle B, Boldt J, Piper S, Schmidt C, Suttner S, Salopek S. The influence of different intravascular volume replacement regimens on renal function in the elderly. Anesth Analg 1999; 89: 1124–30.

    CAS  PubMed  Google Scholar 

  42. Shatney CH, Chaudry IH. Hydroxethylstarch administration does not depress reticuloendothelial function or increase mortality from sepsis. Circ Shock 1994; 13: 21–6.

    Google Scholar 

  43. Dorman T, Breslow MJ. Altered immune function after trauma and hemorrhage: what does it all mean? Crit Care Med 1994; 22: 1069–70.

    CAS  PubMed  Google Scholar 

  44. Seth R, Raymond FD, Makgoba MW. Circulating ICAM-1 isoforms: diagnostic prospects for inflammatory and immune disorders. Lancet 1991; 338: 83–4.

    CAS  PubMed  Google Scholar 

  45. Collis RE, Collins PW, Gutteridge CN, et al. The effect of hydroxyethyl starch and other plasma volume substitutes on endothelial cell activation: an in vitro study. Intensive Care Med 1994; 20: 37–41.

    CAS  PubMed  Google Scholar 

  46. Boldt J, Muller M, Heesen M, Neumann K, Hempelmann GG. Influence of different volume therapies and pentoxifylline infusion on circulating soluble adhesion molecules in critically ill patients. Crit Care Med 1996; 24: 385–91.

    CAS  PubMed  Google Scholar 

  47. Bell RM, Krantz BE, Weigelt JA. ATLS: a foundation for trauma training. Ann Emerg Med 1999; 34: 233–7.

    CAS  PubMed  Google Scholar 

  48. Miller RD. Update on blood transfusions and blood substitutes. Anest Analg 1999; 88(suppl): 71–8.

    Google Scholar 

  49. Velanovich V. Crystalloid versus colloid fluid resuscita- tion: a meta-analysis of mortality. Surgery 1989; 105: 65–71.

    CAS  PubMed  Google Scholar 

  50. Schierhout G, Roberts I. Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a sys- tematic review of randomised trials. BMJ 1998; 316: 961–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  51. Anonymous. Human albumin administration in critical- ly ill patients: systematic review of randomised con- trolled trials. Cochrane Injuries Group Albumin Reviewers. BMJ 1998; 317: 235–40.

  52. Choi FT, Tip G, Quinonez LG, Cook DJ. Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med 1999; 27: 200–10.

    CAS  PubMed  Google Scholar 

  53. Wilkes MM, Navickis RJ. Patient survival after human albumin administration. A meta-analysis of randomized, controlled trials. Ann Intern Med 2001; 135: 149–64.

    CAS  PubMed  Google Scholar 

  54. Cook D, Guyatt G. Colloid use for fluid resuscitation: evidence and spin. Ann Intern Med 2001; 135: 205–8.

    CAS  PubMed  Google Scholar 

  55. Astiz ME, Rackow EC. Crystalloid-colloid controversy revisited. Crit Care Med 1999; 27: 34–5.

    CAS  PubMed  Google Scholar 

  56. Modig J. Effectiveness of dextran 70 versus Ringer’s acetate in traumatic shock and adult respiratory distress syndrome. Crit Care Med 1986; 14: 454–7.

    CAS  PubMed  Google Scholar 

  57. Nagy KK, Davis J, Duda J, Fildes J, Roberts R, Barrett J. A comparison of pentastarch and lactated Ringer’s solution in the resuscitation of patients with hemorrhagic shock. Circ Shock 1993; 40: 289–94.

    CAS  PubMed  Google Scholar 

  58. Sinclair S, James S, Singer M. Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. BMJ 1997; 315: 909–12.

    CAS  PubMed  PubMed Central  Google Scholar 

  59. Evans FA, Madira W, Riyatt MS, Errington M, Heptinstall S. Changes in plasma ionised calcium within 24 hours of trauma in patients infused with the calcium containing colloid Haemaccel during fluid resuscitation. J Accid Emerg Med 1997; 14: 73–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  60. Tounes RN, Tin KC, Amino CJ, Itinoshe M, Roca e Silva M, Birolini D. Use of pentastarch solution in the treatment of patients with hemorrhagic hypovolemia: randomized phase II study in the emergency room. World J Surg 1998; 22: 2–5.

    Google Scholar 

  61. Wu JJ, Huang MS, Tang GJ, et al. Hemodynamic response of modified fluid gelatin compared with lactated ringer’s solution for volume expansion in emergency resuscitation of hypovolemic shock patients: preliminary report of a prospective, randomized trial. World J Surg 2001; 25: 598–602.

    CAS  PubMed  Google Scholar 

  62. Boldt J, Heesen M, Welters I, Fadberg W, Martin K, Hempelmann G Does the type of volume therapy influence endothelial-related coagulation in the critically ill? Br J Anaesth 1995; 75: 740–6.

    CAS  PubMed  Google Scholar 

  63. Boldt J, Muller M, Menges T, Papsdorf M, Hempelmann G. Influence of different volume therapy regimens on regulators of the circulation in the critically ill. Br J Anaesth 1996; 77: 480–7.

    CAS  PubMed  Google Scholar 

  64. Boldt J, Heesen M, Muller M, Pabsdorf M, Hempelmann G. The effects of albumin versus hydroxyethyl starch solution on cardiorespiratory and circulatory variables in critically ill patients. Anesth Analg 1996; 83: 254–61.

    CAS  PubMed  Google Scholar 

  65. Allison KP, Gosling P, Jones S, Pallister I, Porter KM. Randomized trial of hydroxyethyl starch versus gelatine for trauma resuscitation. J Trauma 1999; 47: 1114–21.

    CAS  PubMed  Google Scholar 

  66. Wade CE, Kramer GC, Grady JJ, Fabian TC, Tounes RN. Efficacy of hypertonic 7.5% saline and 6% dextran-70 in treating trauma: a meta-analysis of controlled clinical studies. Surgery 1997; 122: 609–16.

    CAS  PubMed  Google Scholar 

  67. Bunn F, Roberts I, Tasker R, Akpa E. Hypertonic versus isotonic crystalloid for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2002; CD002045.

  68. Holcroft JW, Vassar MJ, Turner JE, Derlet RW, Kramer GC. 3% NaCl and 7.5% NaCl/dextran 70 in the resuscitation of severely injured patients. Ann Surg 1987; 206: 279–88.

    CAS  PubMed  PubMed Central  Google Scholar 

  69. Holcroft JW, Vassar MJ, Perry CA, Gannaway WL, Kramer GC. Use of 7.5% NaCL/6% Dextran 70 solution in the resuscitation of injured patients in the emergency room. Prog Clin Biol Res 1989; 299: 331–8.

    CAS  PubMed  Google Scholar 

  70. Maningas PA, Mattox KL, Pepe PE, Jones RL, Feliciano DV, Burch JM. Hypertonic saline-dextran solutions for the prehospital management of traumatic hypotension. Am J Surg 1989; 157: 528–33.

    CAS  PubMed  Google Scholar 

  71. Vassar MJ, Perry CA, Holcroft JW. Analysis of potential risks associated with 7.5% sodium chloride resuscitation of traumatic shock. Arch Surg 1990; 125: 1309–15.

    CAS  PubMed  Google Scholar 

  72. Mattox KL, Maningas PA, Moore EE, et al. Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension. The U.S.A. Multicenter Trial. Ann Surg 1991; 213: 482–91.

    CAS  PubMed  Google Scholar 

  73. Vassar MJ, Perry CA, Gannaway WL, Holcroft JW. 7.5% sodium chloride/dextran for resuscitation of trauma patients undergoing helicopter transport. Arch Surg 1991; 126: 1065–72.

    CAS  PubMed  Google Scholar 

  74. Younes RN, Aun F, Accioly CQ, Casak LP, Szajnbok I, Birolini D. Hypertonic solutions in the treatment of hypovolemic shock: a prospective, randomized study in patients admitted to the emergency room. Surgery 1992; 111: 380–5.

    CAS  PubMed  Google Scholar 

  75. Vassar MJ, Perry CA, Holcroft JW. Prehospital resuscitation of hypotensive trauma patients with 7.5% NaCl versus 7.5% NaCl with added dextran: a controlled trial. J Trauma 1993; 34: 622–32.

    CAS  PubMed  Google Scholar 

  76. Vassar MJ, Fischer RP, O’Brien PE, et al. A multicenter trial for resuscitation of injured patients with 7.5% sodium chloride. The effect of added dextran 70. Arch Surg 1993; 128: 1003–11.

    CAS  PubMed  Google Scholar 

  77. Younes RN, Aun F, Ching CT, et al. Prognostic factors to predict outcome following the administration of hypertonic/hyperoncotic solution in hypovolemic patients. Shock 1997; 7: 79–83.

    CAS  PubMed  Google Scholar 

  78. de Guzman E, Shankar MN, Mattox KL. Limited volume resuscitation in penetrating thoracoabdominal trauma. AACN Clin Issues 1999; 10: 61–8.

    PubMed  Google Scholar 

  79. Nolan J. Fluid resuscitation for the trauma patient. Resuscitation 2001; 48: 57–69.

    CAS  PubMed  Google Scholar 

  80. Lang K, Boldt J, Suttner S, Haisch G. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery. Anesth Analg 2001; 93: 405–9.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, D-67063, Ludwigshafen, Germany

    Joachim Boldt

Authors
  1. Joachim Boldt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joachim Boldt.

About this article

Cite this article

Boldt, J. RETRACTED ARTICLE: Fluid choice for resuscitation of the trauma patient: a review of the physiological, pharmacological, and clinical evidence. Can J Anesth/J Can Anesth 51, 500–513 (2004). https://doi.org/10.1007/BF03018316

Download citation

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03018316

Keywords

Search

Navigation