Professional Documents
Culture Documents
Objectives
• Target of resuscitation
• Fluid management
• Monitoring
• Strategy in resuscitation
Fluid resuscitation
Definition
1. Rapid intravenous administration of isotonic fluid
to treat volume deficit (volume replacement)
1. Dorland’s Online Medical Dictionary. Available in website: http://www.dorlands.com
2. McGraw−Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw−Hill Companies, Inc.
Pressure (mmHg)
A GFR = 100 mL/min B GFR = 100 mL/min
Pressure (mmHg)
Fig 1. Schematic (A and B) and pathologic kidney with decrease of the total ultrafiltration surface (C and
D) representation of the glomerular capillary hydraulic and oncotic pressure in normal kidney
Target of resuscitation
Target of resuscitation
Target of resuscitation
Target of resuscitation
1. Global O2 delivery
– Mean arterial pressure (MAP)
– Mixed venous O2 saturation (SvO2)*
– O2 Consumption (VO2)
– Other hemodynamic parameters (incl. Global acid-base
status: base deficit* and lactate levels*.
2. Regional O2 delivery
– Gastric ischemia (gastric tonometry: pHim)*.
– Intramuscular pH and pCO2
– Near infrared spectroscopy (NIRS) or tissue electrodes)
*) Prognostic value
Fluids
Total Body Water
Exp:
Adult male 80 kg
TBW 48 L
Intracellular fluid Extracellular fluid Circulation 4.8 L
(ICF, 60%) (ECF, 40%)
Shock
• Classification of shock
Committee on Trauma. American College of Surgeon, 1975
• Assessment
– Clinical (empirical)
– Clinical (objective): hemodynamic parameters
Blood volume :
BVA-100 blood volume analyzer (Daxor Corporation)
- Quantitative method (PCR)
A. Data entry: Height, weight (BVA
computes predicted normal blood
volume for patient)
PCR
Blood sample collection
(Saline lock)
1. Replacement Solutions
• To replace ECF.
• Isotonic.
• Have a [Na+] similar to that of the extracellular fluid which
effectively limits their fluid distribution to the ECF.
• Distributes between the ISF and the plasma in proportion to
their volumes.
• Intracellular fluid volume does not change.
Fluids
1. Replacement Solutions
1. Replacement Solutions
• Normal saline
The prototype crystalloid fluid is 0.9% sodium chloride (NaCl),
also called isotonic saline or normal saline. The latter term is
inappropriate because a one normal (1 N) NaCl solution contains
58 g NaCl per liter (the combined molecular weights of sodium
and chloride), whereas isotonic (0.9%) NaCl contains only 9 g
NaCl per liter
• Lactated Ringers
These anions (eg lactate) are the conjugate base to the corresponding
acid (eg lactic acid) and do not contribute to development of an acidosis
as they are administered with Na+ rather than H+ as the cation.
Fluids
2. Maintenance Solutions
3. Special Solutions
Colloids
A substance microscopically evenly dispersed throughout
another (Greek: glue).
Colloids
• Resuscitation
1. Large volume resuscitation (volume
replacement)
ATLS
Baxter (Parkland formula)
3 to 4 times the volume lost must be administered
WARNING:
Volume (replacement) is NOT improved the perfusion
• Resuscitation
2. Small volume resuscitation
Less is More (Mattox)
To avoid the complication of large volume
resuscitation
(hi Mw solution)
• Slow resuscitation
WARNING:
Rapid administration lead to demyelinated pontine (fatal)
Fluid management
• Fluid challenge
• Fluid challenge
Hydration Status
Hypovolemia : CVP ↑ following administration and
(CVP↓) remain at such a targeted point
achieved
• Fluid treatment
• Volume
• Volume
Monitoring
1. Global O2 delivery
– Mean arterial pressure (MAP)
– Mixed venous O2 saturation (SvO2)*
– O2 Consumption (VO2)
– Other hemodynamic parameters (incl. Global acid-base
status: base deficit* and lactate levels*.
2. Regional O2 delivery
– Gastric ischemia (gastric tonometry: pHim)*.
– Intramuscular pH and pCO2
– Near infrared spectroscopy (NIRS) or tissue electrodes)
Paul E Marik, Xavier Monnet, Jean-Louis Teboul. Hemodynamic parameters to guide fluid therapy. Annals of
Intensive Care 2011, 1:1. http://www.annalsofintensivecare.com/content/1/1/1
Strategy in fluid resuscitation
Colloids versus crystalloids for fluid resuscitation in critically ill patients (Review) 2
Copyright © 2007 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd
This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and
published in The Cochrane Library
2007, Issue 3
Strategy in fluid resuscitation
Implementation