Review Article Resuscitation Fluids The New England Journal of Medicine John A. Mayburgh M.B., Ph.D, Michael G. Maythen M.B September 26, 2013

Review ArticleResuscitation FluidsThe New England Journal of MedicineJohn A. Mayburgh M.B., Ph.D, Michael G. Maythen M.BSeptember 26, 2013Elda Oncossya Panggabean 1061050134

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Fluid resuscitation with colloid and crystalloid solutions is an ubiquitous intervention in acute medicineNo ideal resuscitation fluid existResuscitation FluidsThe New England Journal of MedicineJohn A. Mayburgh M.B., Ph.D, Michael G. Maythen M.BSeptember 26, 2013

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History of Fluid ResuscitationIn 1832, Robert Lewinsthe effects of the IV administration of an alkalinized salt solution in treating patients during the cholera pandemic.The quantity necessary to be injected will probably be found to depend upon the quantity of serum lost; the object being to place the patient in nearly his ordinary state as to the quantity of blood circulating in the vessels

Lewins R. Saline injections into the veins. London Medical Gazette. April 7, 1832:257-68.Resuscitation FluidsThe New England Journal of MedicineJohn A. Mayburgh M.B., Ph.D, Michael G. Maythen M.BSeptember 26, 2013

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History of Fluid Resuscitation1832Robert Lewins1885Sidney Ringerwho modified a physiologic salt solution; Rehydration of children with gastroenteritis

Lee JA. Sydney Ringer (1834-1910) andAlexis Hartmann (1898-1964). Anaesthesia1981;36:1115-21.Development of blood fractionation in 1941human albumin was used for the first time in large quantitiesResuscitation FluidsThe New England Journal of MedicineJohn A. Mayburgh M.B., Ph.D, Michael G. Maythen M.BSeptember 26, 2013

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The Physiology of Fluid Resuscitation

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The Ideal Resuscitation FluidProduces a predictable and sustained increase in intravascular volumeHas a chemical composition as close as possible to that of extracellular fluidMetabolized and completely excreted without accumulation in tissuesDoes not produce adverse metabolic or systemic effectsCost effective in terms of improving patient outcomes

Currently, there is no such fluid available for clinical useResuscitation FluidsThe New England Journal of MedicineJohn A. Mayburgh M.B., Ph.D, Michael G. Maythen M.BSeptember 26, 2013

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The Ideal Resuscitation Fluid

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Type of Resuscitation FluidALBUMINHuman albumin (4 to 5%) in saline is considered to be the reference colloidal solution. It is produced by the fractination of blood and is heat-treated to prevent transmission of pathogenic virusesIt is an expensive solution to produce and distribute, and its availability is limited in low and middle-income countriesResuscitation FluidsThe New England Journal of MedicineJohn A. Mayburgh M.B., Ph.D, Michael G. Maythen M.BSeptember 26, 2013

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A L B U M I NIn 1998, the Cochrane Injuries Group Albumin Reviewers published a meta-analysis comparing the effects of albumin with those of a range of crystalloid solutions in patients with hypovolemia, burns, or hypoalbuminemia and concluded that the administration of albumin was associated with a significant increase in the rate of death (P