Reperfusion Injury After Hemorrhage: A Collective Review

G D. Rushing, MD; L D. Britt, MD, MPH

Disclosures

Annals of Surgery. 2008;247(6):929-937. 

In This Article

Extent of Resuscitation

Extent of resuscitation is the target of several randomized control trials. Supraphysiologic, normotensive, and hypotensive resuscitation have all been evaluated.[15,16,17,18,19,20] In one trial by Dutton et al, with a total of 110 hypotensive patients with blunt and penetrating injuries, mortality was equal in groups administered different volumes of fluid (1000 mL less than in the intervention group).[21] In a study by Dunham et al, a significant difference in mortality was seen in patients administered smaller volumes of fluid via rapid infusion.[22] Although vigorous fluid resuscitation may be lifesaving in some patients, results from clinical trials are inconclusive. Studies with adequate power analysis and appropriate controls are still needed to optimally discern the correct treatment protocols for patients in hemorrhagic shock. Because cellular oxygen utilization is the ultimate goal of resuscitation, several strategies have been proposed to measure cellular oxygen metabolism. Techniques such as gastric tonometry, tissue oxygen electrodes, and microdialysis have had limited use.[23] Complications due to the invasive nature of these techniques, limited monitoring intervals, and inaccurate values are reasons for their restricted clinical use. Near infrared spectroscopy is a portable bedside technique, similar to Doppler, which can be used to measure tissue oxygenation. Results from clinical trials have demonstrated that near infrared spectroscopy is promising.[24,25,26,27] As technology advances, measurement for end points of resuscitation will continue to be a research topic of great interest to surgeons.

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