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  • Print publication year: 2008
  • Online publication date: January 2010

6 - Fluid and Blood Therapy in Trauma

    • By Maxim Novikov, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, Charles E. Smith, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Publisher: Cambridge University Press
  • DOI:
  • pp 101-120



Understand the timing, extent, and the immediate goals for the initial fluid resuscitation in trauma victims, individualized to specific patients.

Review the factors influencing choice of fluid for the initial and ongoing resuscitation.

Discuss factors influencing the decision for initiating transfusion therapy, choice of blood products, immediate and delayed risks and benefits of transfusion therapy.

Become familiar with the current state of therapies intended for the most severely injured patients, including recombinant factor VIIa and massive blood transfusion protocols.

Initial evaluation of an acutely volume-depleted trauma patient will include a primary and secondary survey according to Advanced Trauma Life Support® protocol, an estimate of blood volume deficit (Table 6.1), rate of the ongoing blood loss, and an evaluation of cardiopulmonary reserve and coexisting hepatic or renal dysfunction [1]. The overriding priority of trauma management is to maintain or restore vital organ perfusion and oxygenation above critical levels at an early stage, and to restore perfusion and oxygenation to normal levels as soon as it becomes appropriate. This is best achieved by stopping the bleeding and repleting intravascular volume. Perfusion pressure and oxygenated blood flow to vital organs are important determinants of outcome.

Management priorities in an acutely bleeding trauma patient include ventilation and oxygenation (see Chapter 2), assessment of perfusion, estimation of volume replacement requirements, establishment or verification of adequate intravenous (IV) access (see Chapter 4), measurement of blood pressure, placement of electrocardiogram (ECG), pulse oximeter and capnograph, and laboratory studies.

Stene JK, Smith CE, Grande CM. Evaluation of the trauma patient. In: Longnecker, , Tinker, JH, Morgan, GE, eds. Principles and Practice of Anesthesiology, 2nd edition, St. Louis: Mosby, 1997, pp 572–600.
Grande CM, Smith CE, Stene JK. Trauma anesthesia. In: Longnecker, , Tinker, JH, Morgan, GE, eds. Principles and Practice of Anesthesiology, 2nd edition, St. Louis: Mosby, 1997, pp 2138–64.
Stern, SA, Dronen, SC, Birrer, P, Wang, X.Effect of blood pressure on hemorrhage volume and survival in a near-fatal hemorrhage model incorporating a vascular injury. Ann Emerg Med 1993;22(2):155–63.
Holmes, JF, Sakles, JC, Lewis, G, Wisner, DH.Effects of delaying fluid resuscitation on an injury to the systemic arterial vasculature. Acad Emerg Med 2002;9(4):267–74.
Bickell, WH, Wall, MJ, Pepe, PE, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 1994;331(17):1105–9.
Kwan, I, Bunn, F, Roberts, I. WHO Pre-Hospital Trauma Care Steering Committee. Timing and volume of fluid administration for patients with bleeding. Cochrane Database Syst Rev 2003;3:CD002245. Update: Cochrane Database Syst Rev 2001;1:CD002245.
Roberts, K, Revell, M, Youssef, H, et al. Hypotensive resuscitation in patients with ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2006;31(4):339–44. Epub January 4, 2006.
Krausz, MM.Initial resuscitation of hemorrhagic shock. World J Emerg Surg 2006;1:14.
Lam, AM, Winn, HR, Cullen, BF, Sundling, N.Hyperglycemia and neurological outcome in patients with head injury. J Neurosurg 1991;75(4):545–51.
Michaud, LJ, Rivara, FP, Longstreth, WT Jr, Grady, MS.Elevated initial blood glucose levels and poor outcome following severe brain injuries in children. J Trauma 1991;31(10):1356–62.
Vogelzang, M, Nijboer, JM, Horst, IC, et al. Hyperglycemia has a stronger relation with outcome in trauma patients than in other critically ill patients. J Trauma 2006;60(4):873–7; discussion 878–9.
Conner, TM, Flesner-Gurley, KR, Barner, JC.Hyperglycemia in the hospital setting: The case for improved control among non-diabetics. Ann Pharmacother 2005;39(3):492–501. Epub February 8, 2005.
Berghe, G, Wouters, P, Weekers, F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med 2001;345(19):1359–67.
Berghe, G, Wilmer, A, Milants, I, et al. Intensive insulin therapy in mixed medical/surgical intensive care units: Benefit versus harm. Diabetes 2006;55(11):3151–9.
Ingels, C, Debaveye, Y, Milants, I, et al. Strict blood glucose control with insulin during intensive care after cardiac surgery: Impact on 4-years survival, dependency on medical care, and quality-of-life. Eur Heart J 2006;27(22):2716–24. Epub April 112006.
Hermans, G, Wilmer, A, Meersseman, W, et al. Impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit. Am J Respir Crit Care Med 2007;175(5):480–9.
Shapira, Y, Artru, AA, Cotev, S, et al. Brain edema and neurologic status following head trauma in the rat. No effect from large volumes of isotonic or hypertonic intravenous fluids, with or without glucose. Anesthesiology 1992;77(1):79–85.
Talmor, D, Shapira, Y, Artru, AA, et al. 0.45% saline and 5% dextrose in water, but not 0.9% saline or 5% dextrose in 0.9% saline, worsen brain edema two hours after closed head trauma in rats. Anesth Analg 1998 Jun;86(6):1225–9.
Vink, R, Golding, EM, Williams, JP, McIntosh, TK.Blood glucose concentration does not affect outcome in brain trauma: A 31P MRS study. J Cereb Blood Flow Metab 1997;17(1):50–3.
Ellger, B, Debaveye, Y, Vanhorebeek, I, et al. Survival benefits of intensive insulin therapy in critical illness: Impact of maintaining normoglycemia versus glycemia-independent actions of insulin. Diabetes 2006;55(4):1096–105.
Cull, DL, Lally, KP, Murphy, KD.Compatibility of packed erythrocytes and Ringer's lactate solution. Surg Gynecol Obstet 1991;173(1):9–12.
Vincent, JL, Berre, J.Primer on medical management of severe brain injury. Crit Care Med 2005;33:1392–9.
Scheingraber, S, Rehm, M, Sehmisch, C, Finsterer, U.Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology 1999;90(5):1265–70.
Wilkes, NJ, Woolf, R, Mutch, M, et al. The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesth Analg 2001;93(4):811–6.
Boldt, J, Schöllhorn, T, Münchbach, J, Pabsdorf, M.A total balanced volume replacement strategy using a new balanced hydroxyethyl starch preparation (6% HES 130/0.42) in patients undergoing major abdominal surgery. Eur J Anaesthesiol 2007;24(3):267–75.
Ruttmann, TG, Jamest, MF, Lombard, EH.Haemodilution-induced enhancement of coagulation is attenuated in vitro by restoring antithrombin III to pre-dilution concentrations. Anaesth Intensive Care 2001;29(5):489–93.
Ruttmann, TG, James, MFM, Aronson, I.In vivo investigation into the effects of haemodilution with hydroxyetil starch (200/0.5) and normal saline on coagulation. Br J Anaesth 1998;80:612–6.
Ruttmann, TG, James, MFM, Finlayson J. Effects on coagulation of intravenous crystalloid or colloid in patients undergoing peripheral vascular surgery. Br J Anaesth 2002;89:226–30.
Roche, AM, James, MF, Bennett-Guerrero, E, Mythen, MG.A head-to-head comparison of the in vitro coagulation effects of saline-based and balanced electrolyte crystalloid and colloid intravenous fluids. Anesth Analg 2006;102(4):1274–9.
Kiraly, LN, Differding, JA, Enomoto, TM, et al. Resuscitation with normal saline (NS) vs. lactated ringers (LR) modulates hypercoagulability and leads to increased blood loss in an uncontrolled hemorrhagic shock swine model. J Trauma 2006;61(1):57–64; discussion 64–5.
Waters, JH, Gottlieb, A, Schoenwald, P, et al. Normal saline versus lactated Ringer's solution for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: An outcome study. Anesth Analg 2001;93(4):817–22.
Boldt, J, Haisch, G, Suttner, S, Kumle, B, Schellhase, F.Are lactated Ringer's solution and normal saline solution equal with regard to coagulation?Anesth Analg 2002;94(2):378–84.
Boldt, J.New light on intravascular volume replacement regimens: What did we learn from the past three years?Anesth Analg 2003;97:1595–604.
Gan, TJ.Intraoperative fluid management and choice of fluids. ASA Annual Meeting Refresher Course Lectures 2004;405:1–7.
Boldt, J, Suttner, S.Plasma substitutes. Minerva Anesthesiol 2005;71(12):741–58.
Mythen, MG, Webb, AR.Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg 1995;130:423–9.
SinclairS, S,JamesS, S,Singer, M.Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: Randomised controlled trial. BMJ 1997;315(7113):909–12.
Wilkes, NJ, Woolf, RL, Powanda, MC, et al. Hydroxyethyl starch in balanced electrolyte solution (Hextend) – pharmacokinetic and pharmacodynamic profiles in healthy volunteers. Anesth Analg 2002;94(3):538–44; table of contents.
King, DR, Cohn, SM, Proctor, KG.Changes in intracranial pressure, coagulation, and neurologic outcome after resuscitation from experimental traumatic brain injury with hetastarch. Surgery 2004;136:355–63.
Kellum, JA.Fluid resuscitation and hyperchloremic acidosis in experimental sepsis: Improved short-term survival and acid-base balance with Hextend compared with saline. Crit Care Med 2002;30:300–5.
Boldt, J, Knothe, C, Zickmann, B, et al. Influence of different intravascular volume therapy on platelet function in patients undergoing cardiopulmonary bypass. Anesth Analg 1993;76:1185–90.
Sanfelippo, MJ, Suberviola, PD, Geimer, NF.Development of a von Willebrand-like syndrome after prolonged use of hydroxyethyl starch. Am J Clin Pharmacol 1987;88:653–5.
Gan, TJ, Bennett-Guerrero, E, Phillips-Bute, B, et al. Hextend, a physiologically balanced plasma expander for large volume use in major surgery: A randomized phase III clinical trial. Hextend Study Group. Anesth Analg 1999;88:992–8.
Martin, G, Bennett-Guerrero, E, Wakeling, H, et al. A prospective, randomized comparison of thromboelastographic coagulation profile in patients receiving lactated Ringer's solution, 6% hetastarch in a balanced-saline vehicle, or 6% hetastarch in saline during major surgery. J Cardiothorac Vasc Anesth 2002;16:441–6.
Deusch, E, Thaler, U, Kozek-Langenecker, SA.The effects of high molecular weight hydroxyethyl starch solutions on platelets. Anesth Analg 2004;99(3):665–8.
Finfer, S, Bellomo, R, Boyce, N, et al. SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004;350(22):2247–56.
Lang, K, Boldt, J, Suttner, S, Haisch, G.Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery. Anesth Analg 2001;93(2):405–9, 3rd contents page.
Boldt, J, Ducke, M, Kumle, B, et al. Influence of different volume replacement strategies on inflammation and endothelial activation in the elderly undergoing major abdominal surgery. Intensive Care Med 2004;30(3):416–22. Epub January 8 2004.
London, MJ.Colloids versus crystalloids in cardiopulmonary bypass. Pro: Colloids should be added to the pump prime. J Cardiothorac Anesth 1990;4:401.
Wagner, K, Smith, CE, Avula, R.Intraoperative Hextend administration in trauma patients requiring surgery. Poster presentation at The International Trauma Anesthesia and Critical Care Society (ITACCS) Annual Scientific Meeting, Las Vegas, May 2007.
Roberts, I, Alderson, P, Bunn, F, et al. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2004;4:CD000567. Update: Cochrane Database Syst Rev 2000;2:CD000567.
Boldt, J. Fluid choice for resuscitation in trauma. In Smith, CE, Rosenberg, AD, Grande, CM, ed. Massive Transfusion and Control of Hemorrhage in the Trauma Patient. ITACCS: 2007 (in press).
Spittal, MJ, Findlay, GP.The seven year itch. Anaesthesia 1995;50:913–4.
Cullen, MJ, Singer, M.Severe analphylactoid reaction to hydroxyethyl starch. Anaesthesia 1990;45:1041–2.
Nearman, HS, Herman, ML.Toxic effects of colloids in the intensive care unit. Crit Care Clin 1991;7:713–23.
Barron, ME, Wilkes, MM, Navickis, RJ.A systematic review of the comparative safety of colloids. Arch Surg 2004;139:552–63.
Boldt, J.Fluid choice for resuscitation of the trauma patient: A review of the physiological, pharmacological, and clinical evidence. Can J Anesth 2004;51:500–13.
Treib, J, Baron, JF, Grauer, MT, Strauss, RG.An international view of hydroxyethyl starches. Intensive Care Med 1999;25(3):258–68.
Huttner, I, Boldt, J, Haisch, G, et al. Influence of different colloids on molecular markers of haemostasis and platelet function in patients undergoing major abdominal surgery. Br J Anaesth 2000;85(3):417–23.
Wilson RF. Blood replacement. In Wilson, RF, Walt, A, ed. Management of Trauma. Pitfalls and Practice, 2nd edition. Baltimore: Williams & Wilkins, 1996.
Knutson, JE, Deering, JA, Hall, FW, et al. Does intraoperative hetastarch administration increase blood loss and transfusion requirements after cardiac surgery?Anesth Analg 2000;90(4):801–7.
Kozek-Langenecker, SA.Effects of hydroxyethyl starch solutions on hemostasis. Anesthesiology 2005;103(3):654–60.
Sedrakyan, A, Gondek, K, Paltiel, D, Elefteriades, JA.Volume expansion with albumin decreases mortality after coronary artery bypass graft surgery. Chest 2003;123(6):1853–7.
Nielsen, VG.Effects of hydroxyethyl starch and calcium on platelet activation. Anesth Analg 2005;100(5):1538–9.
Margarson, MP, Soni, N.Serum albumin: Touchstone or totem?Anaesthesia 1998;53:789–803.
Qiao, R, Siflinger-Birnboim, A, Lum, H, Tiruppathi, C, Malik, AN.Albumin and Ricinus communis agglutinin decrease endothelial permeability via interactions with matrix. Am J Physiol 1993;265:C439–46.
Weil, MH, Henning, RJ, Puri, VK.Colloid oncotic pressure: clinical significance. Crit Care Med 1979;7:113–26.
Fleck, A, Raines, G, Hawker, F, et al. Increased vascular permeability: A major cause of hypoalbuminaemia in disease and injury. Lancet 1985;i:781–4.
Rackow, EC, Mecher, C, Astiz, ME, et al. Effects of pentastarch and albumin infusion on cardiorespiratory function and coagulation in patients with severe sepsis and systemic hypoperfusion. Crit Care Med 1989;17:394–8.
Drobin, D, Hahn, RG.Kinetics of isotonic and hypertonic plasma volume expanders. Anesthesiology 2002;96(6):1371–80.
Wade, CE, Hannon, JP, Bossone, CA, Hunt, MM.Superiority of hypertonic saline/dextran over hypertonic saline during the first 30 min of resuscitation following hemorrhagic hypotension in conscious swine. Resuscitation 1990;20(1):49–56.
T⊘ll⊘f, srud S, Elgjo, GI, Prough, DS, et al. The dynamics of vascular volume and fluid shifts of lactated ringer's solution and hypertonic-saline-dextran solutions infused in normovolemic sheep. Anesth Analg 2001;92:823–31.
Askenasy, N, Navon, G.Continuous monitoring of intracellular volumes in isolated rat hearts during normothermic perfusion and ischemia. J Magn Reson 1997;124(1):42–50.
Nakayama, S, Kramer, GC, Carlsen, RC, Holcroft, JW.Infusion of very hypertonic saline to bled rats: Membrane potentials and fluid shifts. J Surg Res 1985;38(2):180–6.
Mazzoni, MC, Borgstrom, P, Intaglietta, M, Arfors, KE.Lumenal narrowing and endothelial cell swelling in skeletal muscle capillaries during hemorrhagic shock. Circ Shock 1989;29(1):27–39.
Mazzoni, MC, Borgstrom, P, Intaglietta, M, Arfors, KE.Capillary narrowing in hemorrhagic shock is rectified by hyperosmotic saline-dextran reinfusion. Circ Shock 1990;31(4):407–18.
Toung, TJ, Chang, Y, Lin, J, Bhardwaj, A.Increases in lung and brain water following experimental stroke: Effect of mannitol and hypertonic saline. Crit Care Med 2005;33(1):203–8; discussion 259–60.
Vassar, MJ, Fischer, RP, Brien, O' PE, et al. A multicenter trial for resuscitation of injured patients with 7.5% sodium chloride. The effect of added dextran 70. The Multicenter Group for the Study of Hypertonic Saline in Trauma Patients. Arch Surg 1993;128(9):1003–11; discussion 1011–3.
Kramer, GC, Perron, PR, Lindsey, DC, Ho, HS, Gunther, RA, Boyle, WA.Small-volume resuscitation with hypertonic saline dextran solution. Surgery 1986;100:239–46.
Jarhult, J, Hillman, J, Mellander, S.Circulatory effects evoked by ‘physiological’ increases of arterial osmolality. Acta Physiol Scand 1975;93(1):129–34.
Kien, ND, Kramer, GC, White, DA.Acute hypotension caused by rapid hypertonic saline infusion in anesthetized dogs. Anesth Analg 1991;73:597–602.
Mouren, S, Delayance, S, Mion, G, et al. Mechanisms of increased myocardial contractility with hypertonic saline solutions in isolated blood-perfused rabbit hearts. Anesth Analg 1995;81(4):777–82.
Matthew, CB, Durkot, MJ, Patterson, DR.Fluid shifts induced by the administration of 7.5% sodium chloride in 6% dextran 70 (HSD) in dehydrated swine. Circ Shock 1993;41(3):150–5.
Ho, HS, Sondeen, JL, Dubick, MA, et al. The renal effects of 7.5% NaCl-6% dextran-70 versus lactated Ringer's resuscitation of hemorrhage in dehydrated sheep. Shock 1996;5(4):289–97.
Harutjunyan, L, Holz, C, Rieger, A, et al. Efficiency of 7.2% hypertonic saline hydroxyethyl starch 200/0.5 versus mannitol 15% in the treatment of increased intracranial pressure in neurosurgical patients – A randomized clinical trial. Crit Care 2005;9(5):R530–40.
Battison, C, Andrews, PJ, Graham, C, Petty, T.Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% Saline/6% dextran solution on increased intracranial pressure after brain injury. Crit Care Med 2005;33(1):196–202; discussion 257–8.
Tseng, M-Y, , Al-Rawi PG, Pickard, JD, et al. Effect of hypertonic saline on cerebral blood flow in poor-grade patients with subarachnoid hemorrhage. Stroke 2003;34:1389–96.
Schwarz, S, Georgiadis, D, Aschoff, A, Schwab, S.Effects of hypertonic (10%) saline in patients with raised intracranial pressure after stroke. Stroke 2002;33(1):136–40. Comment in: Stroke 2002;33(4):11667; author reply 1166–7.
Bentsen, G, Breivik, H, Lundar, T, Stubhaug, A.Predictable reduction of intracranial hypertension with hypertonic saline hydroxyethyl starch: A prospective clinical trial in critically ill patients with subarachnoid haemorrhage. Acta Anaesthesiol Scand 2004;48(9):1089–95.
Vialet, R, Albanese, J, Thomachot, L, Antonini, F, Bourgouin, A, Alliez, B, Martin, C.Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2 mL/kg 7.5% saline is more effective than 2 mL/kg 20% mannitol. Crit Care Med 2003;31(6):1683–7.
Ware, ML, Nemani, VM, Meeker, M, et al. Effects of 23.4% sodium chloride solution in reducing intracranial pressure in patients with traumatic brain injury: A preliminary study. Neurosurgery 2005;57(4):727–36; discussion 727–36.
Khanna, S, Davis, D, Peterson, B, et al. Use of hypertonic saline in the treatment of severe refractory posttraumatic intracranial hypertension in pediatric traumatic brain injury. Crit Care Med 2000;28(4):1144–51.
Wade, CE, Grady, JJ, Kramer, GC, et al. Individual patient cohort analysis of the efficacy of hypertonic saline/dextran in patients with traumatic brain injury and hypotension. J Trauma 1997;42(5S) (Suppl):61S–5S.
Cooper, DJ, Myles, PS, McDermott, FT, et al. Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury. JAMA 2004;291:1350–7.
Rizoli, SB, Rhind, SG, Shek, PN, et al. The immunomodulatory effects of hypertonic saline resuscitation in patients sustaining traumatic hemorrhagic shock: A randomized, controlled, double-blinded trial. Ann Surg 2006;243(1):47–57.
Bunn, F, Roberts, I, Tasker, R, Akpa, E.Hypertonic versus near isotonic crystalloid for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev 2004;3:CD002045. Update: Cochrane Database Syst Rev 2002;1:CD002045.
Carson, JL, Noveck, H, Berlin, JA, Gould, SA.Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion. Transfusion 2002;42(7):812–8.
Licker, M, Ellenberger, C, Sierra, J, et al. Cardiovascular response to acute normovolemic hemodilution in patients with coronary artery diseases: Assessment with transesophageal echocardiography. Crit Care Med 2005;33(3):591–7.
Levy, PS, Kim, SJ, Eckel, PK, et al. Limit to cardiac compensation during acute isovolemic hemodilution: Influence of coronary stenosis. Am J Physiol 1993;265(1 Pt 2):H340–9.
Spahn, DR, Smith, LR, Veronee, CD, et al. Acute isovolemic hemodilution and blood transfusion. Effects on regional function and metabolism in myocardium with compromised coronary blood flow. J Thorac Cardiovasc Surg 1993;105(4):694–704.
Hopf, HW, Viele, M, Watson, JJ.Subcutaneous perfusion and oxygen during acute severe isovolemic hemodilution in healthy volunteers. Arch Surg 2000;135(12):1443–9.
Leung, JM, Weiskopf, RB, Feiner, J, et al. Electrocardiographic ST-segment changes during acute, severe isovolemic hemodilution in humans. Anesthesiology 2000;93(4):1004–10.
Weiskopf, RB, Toy, P, Hopf, HW, et al. Acute isovolemic anemia impairs central processing as determined by P300 latency. Clin Neurophysiol 2005;116(5):1028–32. Epub January 25, 2005.
Weiskopf, RB, Viele, MK, Feiner, J, et al. Human cardiovascular and metabolic response to acute, severe isovolemic anemia. JAMA 1998;279(3):217–21.
Spahn, DR, Zollinger, A, Schlumpf, RB, et al. Hemodilution tolerance in elderly patients without known cardiac disease. Anesth Analg 1996;82(4):681–6.
Mathru, M, Kleinman, B, Blakeman, B, et al. Cardiovascular adjustments and gas exchange during extreme hemodilution in humans. Crit Care Med 1991;19(5):700–4.
Ickx, BE, Rigolet, M, Linden, PJ.Cardiovascular and metabolic response to acute normovolemic anemia. Effects of anesthesia. Anesthesiology 2000;93(4):1011–6.
Viele, MK, Weiskopf, RB.What can we learn about the need for transfusion from patients who refuse blood? The experience with Jehovah's Witnesses. Transfusion 1994;34(5):396–401.
Neff, TA, Stocker, R, Wight, E, Spahn, DR.Extreme intraoperative blood loss and hemodilution in a Jehovah's Witness: New aspects in postoperative management. Anesthesiology 1999;91(6):1949–51.
Zollinger, A, Hager, P, Singer, T, et al. Extreme hemodilution due to massive blood loss in tumor surgery. Anesthesiology 1997;87(4):985–7.
Fang, WC, Helm, RE, Krieger, KH, et al. Impact of minimum hematocrit during cardiopulmonary bypass on mortality in patients undergoing coronary artery surgery. Circulation 1997;96(9 Suppl):II-194–9.
Pape, A, Meier, J, Kertscho, H, et al. Hyperoxic ventilation increases the tolerance of acute normovolemic anemia in anesthetized pigs. Crit Care Med 2006;34(5):1475–82.
Meier, J, Kemming, G, Meisner, F, et al. Hyperoxic ventilation enables hemodilution beyond the critical myocardial hemoglobin concentration. Eur J Med Res 2005;10(11):462–8.
Meier, J, Kemming, GI, Kisch-Wedel, H, et al. Hyperoxic ventilation reduces six-hour mortality after partial fluid resuscitation from hemorrhagic shock. Shock 2004;22(3):240–7.
Meier, J, Kemming, GI, Kisch-Wedel, H, et al. Hyperoxic ventilation reduces 6-hour mortality at the critical hemoglobin concentration. Anesthesiology 2004;100(1):70–6.
Weiskopf, RB, Feiner, J, Hopf, HW, et al. Oxygen reverses deficits of cognitive function and memory and increased heart rate induced by acute severe isovolemic anemia. Anesthesiology 2002;96(4):871–7.
Suttner, S, Piper, SN, Kumle, B, et al. The influence of allogenic red blood cell transfusion compared with 100% oxygen ventilation on systemic oxygen transport and skeletal muscle oxygen tension after cardiac surgery. Anesth Analg 2004;40:457–60.
Marik, PE, Sibbald, WJ.Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 1993;269(23):3024–9.
Hebert, PC, Wells, G, Blajchman, MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999;340(6):409–17.
McIntyre, L, Hebert, PC, Wells, G, et al. Is a restrictive transfusion strategy safe for resuscitated and critically ill trauma patients?J Trauma 2004;57(3):563–8; discussion 568.
Hebert, PC, Yetisir, E, Martin, C, et al. Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases?Crit Care Med 2001;29(2):227–34.
Rao, SV, Jollis, JG, Harrington, RA, et al. Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. JAMA 2004;292(13):1555–62.
Wu, WC, Rathore, SS, Wang, Y, et al. Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med 2001;345(17):1230–6.
Practice Guidelines for Perioperative Blood Transfusion and Adjuvant Therapies. An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies (approved by the House of Delegates on October 22, 1995 and last amended on October 25, 2005).
Gervin, AS, Fischer, RP.Resuscitation of trauma patient with type-specific uncrossmatched blood. J Trauma 1984;24:327.
Murray, OJ, Pennell, BJ, Weinstein, SL, Olson, JD.Packed red cells in acute blood loss: Dilutional coagulopathy as a cause of surgical bleeding. Anesth Analg 1995;80:336.
Murray, OJ, Olson, JD, Strauss, R, Tinker, JH.Coagulation changes during packed red cell replacement of major blood loss. Anesthesiology 1988;69:839.
Leslie, SO, Toy, PT.Laboratory hemostatic abnormalities in massively transfused patients given red blood cells and crystalloid. Am J Clin Patho1 1991;96:770.
Sohmer, PR, Scott, RL.Massive transfusion. Clin Lab Med 1982;2:21.
Haan, J, Scalea, T.A Jehovah's Witness with complex abdominal trauma and coagulopathy: use of factor VII and a review of the literature. Am Surg 2005;71(5):414–5.
Klitgaard, T, Tabanera, y Palacios R, Boffard, KD, et al. NovoSeven Trauma Study Group. Pharmacokinetics of recombinant activated factor VII in trauma patients with severe bleeding. Crit Care 2006;10(4):R104.
Kenet, G, Walden, R, Eldad, A, Martinowitz, U.Treatment of traumatic bleeding with recombinant factor VIIa. Lancet 1999;354(9193):1879.
Boffard, KD, Riou, B, Warren, B, et al. NovoSeven Trauma Study Group. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials. J Trauma 2005;59(1):8–15; discussion 15–8.
Rizoli, SB, Boffard, KD, Riou, B, et al. NovoSeven Trauma Study Group. Recombinant activated factor VII as an adjunctive therapy for bleeding control in severe trauma patients with coagulopathy: subgroup analysis from two randomized trials. Crit Care 2006;10(6):R178.
Stein, DM, Dutton, RP, Connor, O' J, Alexander, M, Scalea, TM.Determinants of futility of administration of recombinant factor VIIa in trauma. J Trauma 2005;59(3):609–15.
Dutton, RP, McCunn, M, Hyder, M, et al. Factor VIIa for correction of traumatic coagulopathy. J Trauma 2004;57(4):709–18; discussion 718–9.
Thomas, GO, Dutton, RP, Hemlock, B, et al. Thromboembolic complications associated with factor VIIa administration. J Trauma 2007;62(3):564–9.
Mayer, SA, Brun, NC, Begtrup, K, et al. Recombinant Activated Factor VII Intracerebral Hemorrhage Trial Investigators. Recombinant activated factor VII for acute intracerebral hemorrhage. N Engl J Med 2005;352(8):777–85.
Malone, DL, Hess, JR, Fingerhut, A.Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol. J Trauma 2006;60(6 Suppl):S91–6.
Forestner JE. Massive transfusion protocols in trauma care. In Smith, CE, ed. Trauma Anesthesia: Basic and Clinical Aspects, Chapter 7. Cambridge University Press, New York.
Hirshberg, A, Dugas, M, Banez, EI, Scott, BG, Wall, MJ Jr, Mattox, KL: Minimizing dilutional coagulopathy in exsanguinating hemorrhage: A computer simulation. J Trauma 2003;54:454–63.
Armand, R, Hess, JR.Treating coagulopathy in trauma patients. Transfus Med Rev 2003;17:223–31.
MacLeod, JB, Lynn, M, McKenney, MG, et al. Early coagulopathy predicts mortality in trauma. J Trauma 2003;55(1):39–44.
Gonzalez, EA, Moore, FA, Holcomb, JB, et al. Fresh frozen plasma should be given earlier to patients requiring massive transfusion. J Trauma 2007;62(1):112–9.
Maegele, M, Lefering, R, Yucel, N, et al. Early coagulopathy in multiple injury: An analysis from the German Trauma Registry on 8724 patients. Injury 2007;38(3):298–304. Epub January 9, 2007.
Brohi, K, Cohen, MJ, Ganter, MT, et al. Acute traumatic coagulopathy: Initiated by hypoperfusion: Modulated through the protein c pathway?Ann Surg 2007;245(5):812–8.
Kauvar, DS, Lefering, R, Wade, CE.Impact of hemorrhage on trauma outcome: An overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma 2006;60:S3–11.
Kauvar, DS, Holcomb, JB, Norris, GC, Hess, JR.Fresh whole blood transfusion: A controversial military practice. J Trauma 2006;61(1):181–4.
Repine, TB, Perkins, JG, Kauvar, DS, Blackborne, L.The use of fresh whole blood in massive transfusion. J Trauma 2006;60(6 Suppl):S59–69.
Malone, DL, Dunne, J, Tracy, JK, et al. Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma 2003;54(5):898–905; discussion905–7.
Mostafa, G, Gunter, OL, Norton, HJ, et al. Age, blood transfusion, and survival after trauma. Am Surg 2004;70(4):357–63.
Opelz, G, Vanrenterghem, Y, Kirste, G, et al. Prospective evaluation of pretransplant blood transfusions in cadaver kidney recipients. Transplantation 1997;63(7):964–7.
Tartter, PI, Steinberg, B, Barron, DM, Martinelli, G.Transfusion history, T cell subsets and natural killer cytotoxicity in patients with colorectal cancer. Vox Sang 1989;56(2):80–4.
Jensen, LS, Andersen, AJ, Christiansen, PM, et al. Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery. Br J Surg 1992;79(6):513–6.
Weber, EW, Slappendel, R, Prins, MH, et al. Perioperative blood transfusions and delayed wound healing after hip replacement surgery: Effects on duration of hospitalization. Anesth Analg 2005;100(5):1416–21.
Ohwada, S, Sato, Y, Sato, N, et al. Effects of transfusion on gastrointestinal anastomotic wound healing and leukocyte function in rats. Eur Surg Res 2000;32(6):353–8.
Ciesla, DJ, Moore, EE, Johnson, JL, et al. Multiple organ dysfunction during resuscitation is not postinjury multiple organ failure. Arch Surg 2004;139(6):590–4; discussion 594–5.
Zallen, G, Offner, PJ, Moore, EE, et al. Age of transfused blood is an independent risk factor for postinjury multiple organ failure. Am J Surg 1999;178(6):570–2.
Gould, S, Cimino, MJ, Gerber, DR.Packed red blood cell transfusion in the intensive care unit: Limitations and consequences. Am J Crit Care 2007;16(1):39–48; quiz 49.
Utter, GH, Nathens, AB, Lee, TH, et al. Leukoreduction of blood transfusions does not diminish transfusion-associated microchimerism in trauma patients. Transfusion 2006;46(11):1863–9.
Jensen, LS, Hokland, M, Nielsen, HJ.A randomized controlled study of the effect of bedside leucocyte depletion on the immunosuppressive effect of whole blood transfusion in patients undergoing elective colorectal surgery. Br J Surg 1996;83(7):973–7.
Hebert, PC, Fergusson, D, Blajchman, MA, et al. Clinical outcomes following institution of the Canadian universal leukoreduction program for red blood cell transfusions. JAMA 2003;289(15):1941–9.
Taylor, RW, Brien, O' J, Trottier, SJ, et al. Red blood cell transfusions and nosocomial infections in critically ill patients. Crit Care Med 2006;34(9):2302–8.
Blumberg, N, Fine, L, Gettings, KF, Heal, JM.Decreased sepsis related to indwelling venous access devices coincident with implementation of universal leukoreduction of blood transfusions. Transfusion 2005;45(10):1632–9.
Swanson, K, Dwyre, DM, Krochmal, J, Raife, TJ.Transfusion-related acute lung injury (TRALI): Current clinical and pathophysiologic considerations. Lung 2006;184(3):177–85.
Bux, J, Sachs, UJ.The pathogenesis of transfusion-related acute lung injury (TRALI). Br J Haematol 2007;136(6):788–99.
Sessler, DI.Perianesthetic thermoregulation and heat balance in humans. FASEB J 1993:7:638–44.
Smith, CE, Patel, N.Hypothermia in adult trauma patients: Anesthetic considerations. Part 1: Etiology and pathophysiology. Am J Anesthesiol 1996;23:283.
Smith, CE, Patel, N.Hypothermia in adult trauma patients: anesthetic considerations. Part 11: Prevention and treatment. Am J Anesthesiol 1997;24:29.
Reed, RI, Johnston, TO, Hudson, D, Fischer, RP.The disparity between hypothermic coagulopathy and clotting studies. J Trauma 1992;33:465.
Reed, RL, Bracey, AW, Hudson, JO, et aI. Hypothermia and blood coagulation: dissociation between enzyme activity and clotting factor levels. Circ Shock 1990;32:141.
Valeri, CR, MacGregor, H, Cassidy, G, et al. Effects of temperature on bleeding time and dotting time in normal male and female volunteers. Crit Care Med 1995;23:698.
Jurkovich, GH, Greiser, WR, Luterman, A, et al. Hypothermia in trauma victims: An ominous predictor of survival. J Trauma 1987;27:1019.
Novikov, M, Avula, R, Smith, CE, Jernigan, JR.Does hypothermia predict mortality in trauma patients? a hypothesis revisited. Poster presentation at The International Trauma Anesthesia and Critical Care Society (ITACCS) Annual Scientific Meeting, Las Vegas. May 2007.
Gentilello, LM, Moujaes, S.Treatment of hypothermia in trauma victims: thermodynamic considerations. J Intensive Care Med 1995;10:5.
Mendlowitz, M.The specific heat of human blood. Science 1948;107:97.
Patel, N, Knapke, D, Smith, CE, et al. Simulated clinical evaluation of conventional and newer fluid warming devices. Anesth Analg 1996;82:517–24.
Kahn, RC, Jaseo, HD, Carlon, GC, et al. Massive blood replacement: Correlation of ionized calcium, citrate, and hydrogen ion concentration. Anesth Analg 1979;58:274.
Insalaco, SJ.Massive transfusion. LabME 1984;15:325.
Arrington, P, McNamara, JJ.Mechanism of microaggregate formation in stored blood. Ann Surg 1974;179:146.
Marcucci, C, Madjdpour, C, Spahn, DR.Allogeneic blood transfusions: Benefit, risks and clinical indications in countries with a low or high human development index. Br Med Bull 2004;70:15–28.
Scalea, TM, Hartnett, RW, Ouncan, AO, et al. Central venous oxygen saturation: A useful clinical tool in trauma patients. J Trauma 1990;30:1539.
Patel, N, Smith, CE, Pinchak, AC.Clinical comparison of blood warmer performance during simulated clinical conditions. Can J Anaesth 1995;42:636.