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Resuscitation from severe hemorrhage

 

作者: William C. MD Shoemaker,   Andrew B. MD Peitzman,   Ronald MD Bellamy,   Rinaldo MD Bellomo,   Stephen P. PhD Bruttig,   Antonio MD Capone,   Michael PhD Dubick,   George C. PhD Kramer,   Jack E. PhD McKenzie,   Paul E. MD Pepe,   Peter MD Safar,   Robert MD Schlichtig,   John W. MD Severinghaus,   Samuel A. MD Tisherman,   Lars MD Wiklund,  

 

期刊: Critical Care Medicine  (OVID Available online 1996)
卷期: Volume 24, issue 2  

页码: 12-23

 

ISSN:0090-3493

 

年代: 1996

 

出版商: OVID

 

数据来源: OVID

 

摘要:

The potential to be successfully resuscitated from severe traumatic hemorrhagic shock is not only limited by the ``golden 1 hr,'' but also by the ``brass (or platinum) 10 mins'' for combat casualties and civilian trauma victims with traumatic exsanguination.One research challenge is to determine how best to prevent cardiac arrest during severe hemorrhage, before control of bleeding is possible. Another research challenge is to determine the critical limits of, and optimal treatments for, protracted hemorrhagic hypotension, in order to prevent ``delayed'' multiple organ failure after hemostasis and all-out resuscitation. Animal research is shifting from the use of unrealistic, pressure-controlled, hemorrhagic shock models and partially realistic, volume-controlled hemorrhagic shock models to more realistic, uncontrolled hemorrhagic shock outcome models. Animal outcome models of combined trauma and shock are needed; a challenge is to find a humane and clinically realistic long-term method for analgesia that does not interfere with cardiovascular responses.Clinical potentials in need of research are shifting from normotensive to hypotensive (limited) fluid resuscitation with plasma substitutes.Topics include optimal temperature, fluid composition, analgesia, and pharmacotherapy. Hypotensive fluid resuscitation in uncontrolled hemorrhagic shock with the addition of moderate resuscitative (28 degrees to 32 degrees C) hypothermia looks promising in the laboratory. Regarding the composition of the resuscitation fluid, despite encouraging results with new preparations of stroma-free hemoglobin and hypertonic salt solutions with colloid, searches for the optimal combination of oxygen-carrying blood substitute, colloid, and electrolyte solution for limited fluid resuscitation with the smallest volume should continue. For titrating treatment of shock, blood lactate concentrations are of questionable value, although metabolic acidemia seems helpful for prognostication. Development of devices for early noninvasive monitoring of multiple parameters in the field is indicated. Molecular research applies more to protracted hypovolemic shock followed by the systemic inflammatory response syndrome or septic shock, which were not the major topics of this discussion.(Crit Care Med 1996; 24(Suppl):S12-S23)

 



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