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WHEN TO FLUID RESUSCITATE IN HAEMORRHAGIC SHOCK
At present there is much debate about when is the best time to give fluids in haemorrhagic shock. The previous Advanced Trauma Life Support teaching of immediate and aggressive fluid resuscitation has been challenged. As a result, the practice of hypotensive resuscitation is being performed more frequently, particularly in the prehospital setting. However, a recent study from Taiwan using rats (
) provides evidence to suggest that delayed fluid resuscitation may not guarantee the best long-term outcome. Those rats who received delayed resuscitation greater than 45 mins had an increased production of pro-inflammatory cytokines and reduced production of anti-inflammatory cytokines. Perhaps limited fluid resuscitation may be the best option, avoiding the rebleeding from early over-aggressive intravenous fluids and the cytokine effects from delayed resuscitation.
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