Posted by Matthew Mac Partlin on Friday, March 9, 2012The
European Society of Intensive Care Medicine recently issued a consensus statement on volume therapy in critically ill patients , in which they make 10 recommendations in all, based on the
GRADE system. Of interest to the motorsport medical community is their recommendations on choice of fluid for trauma, traumatic brain injury and burns.
Recommendation 4 states that albumin and synthetic colloids (e.g. gelofusin, hydroxyethyl starch) should not be used for volume resuscitation of a patient with a traumatic brain injury (Grade 1C - strong recommendation based on weak evidence).
Recommendation 5 suggests that gelatins should be avoided in patients at risk of acute kidney injury or bleeding (Grade 2C - probably reasonable but weak evidence)
Recommendation 8 suggests that hypertonic solutions should not be used in volume resuscitation outside of clinical trials (Grade 2C), which is interesting given the military interest in using these fluids for combat resuscitation.
While this consensus statement provokes thought, it is not a set of guidelines and no doubt will prompt debate amongst various regions and groups as to its degree of influence on practice. Perhaps it should, however, stimulate our own agencies to consider the contents of resuscitation packs that are used at motorsport events. While the evidence base is admittedly weak, trends are suggested in the trauma populations and perhaps it could be argued that as things stand, using only crystalloid as a resuscitation fluid in these patients may result in the least potential harm.
References
