The controversy continues

The choice of fluids remains controversial. Although most agree that crystalloids are effective in initial resuscitation of hemorrhagic shock from trauma, there may be other advantages to hypertonic solutions and investigations of combinations of hypertonic solutions, dextran, and hydroxyethyl starch are ongoing ( Mattoxefa/ 1991).

Once resuscitation is complete in a critically ill patient, hemodynamic variables and serology should be evaluated in order to determine whether crystalloids, colloids, or blood component therapy are necessary. Concerns may range from permeability defects, such as loss of integrity of the alveolar capillary membrane with subsequent transudation of large molecules with free water leading to the onset of acute respiratory distress syndrome, to the risk of viral transmission ( V§!§Qoy,!ch 1989). In these circumstances clinical evaluation coupled with invasive hemodynamic monitoring may help to guide fluid therapy.

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