Vigorous intravenous fluid resuscitation has become widely accepted as the optimum management of hemorrhagic shock in trauma. There is now, however, sufficient evidence for this position to be reviewed. Hypotensive or delayed resuscitation has been postulated as a means by which the mortality associated with treatment can be reduced. It has been suggested that overresuscitation with intravenous fluids may worsen hemorrhage. This article discusses the possible adverse effects of “conventional” resuscitation and examines the evidence to support alternative treatment modalities.
From the Department of Orthopaedic Surgery, Coventry and Warwick Hospital (M.R.), Coventry, Emergency Medicine, British Army (I.G.), and Trauma and Orthopaedic Surgery, University Hospital (K.P.), Birmingham, United Kingdom.
Submitted for publication January 21, 2002.
Accepted for publication December 20, 2002.
Address for reprints: Ian Greaves, MD, Emergency Medicine, Peterborough District Hospital, Thorpe Road, Peterborough PE3 6DA, United Kingdom.