Critical Care Medicine
N Engl J Med 2013;369:1243-51.
The Ideal Resuscitation Fluid
- produces a predictable and sustained increase in intravascular volume
- has a chemical composition as close as possible to that of extracellular fluid
- is metabolized and completely excreted without accumulation in tissues
- does not produce adverse metabolic or systemic effects
- is cost-effective in terms of improving patient outcomes
- Currently, there is no such fluid available for clinical use
- colloid solutions: more effective in expanding intravascular volume
- 1:3 ratio of colloids to crystalloids to maintain intravascular volume
- semisynthetic colloids have a shorter duration of effect than human albumin solutions
- crystalloids: resuscitation fluids
Specific Considerations Apply To Different Categories Of Patients
- Bleeding patients require control of hemorrhage and transfusion with red cells and blood components as indicated.
- Isotonic, balanced salt solutions are a pragmatic initial resuscitation fluid for the majority of acutely ill patients.
- Consider saline in patients with hypovolemia and alkalosis.
- Consider albumin during the early resuscitation of patients with severe sepsis.
- Saline or isotonic crystalloids are indicated in patients with traumatic brain injury.
- Albumin is not indicated in patients with traumatic brain injury.
- Hydroxyethyl starch is not indicated in patients with sepsis or those at risk for acute kidney injury.
- The safety of other semisynthetic colloids has not been established, so the use of these solutions is not recommended.
- The safety of hypertonic saline has not been established.
- The appropriate type and dose of resuscitation fluid in patients with burns has not been determined.
- Colloid 與 crystalloid solution 兩種復甦溶液對於升壓的效果並無差異。
- Albumin 是Colloid 代表溶液，其價格限制了其使用性。Albumin 使用在大部分急重症病患復甦是安全的，特別是嚴重敗血症患者的早期復甦。然而創傷性腦損傷的病患，Albumin 使用會增加死亡率。
- ICU 病患使用Hydroxyethyl starch (HES) 會增加急性腎傷害及洗腎的風險！