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Endpoints in clinical trials of fluid resuscitation of patients with traumatic injuries

Abstract : Trauma is a is a worldwide problem with severe and extensive consequences impacting individuals and society as a whole. Death due to traumatic injuries is the leading cause of death of individuals between the ages of 1 and 44 years. Hemorrhage is a major contributor to the predicament of traumatic injury and care. The initial treatment of patients with traumatic injuries who are hypotensive because of hemorrhage is believed to be paramount to their survival. After assuring adequate respiration and control of bleeding, early resuscitation with fluids has been advocated for victims of traumatic injuries. The goal of fluid intervention is to replace the volume of blood lost during hemorrhage, thus increasing oxygen delivery to the tissues and ultimately improving survival. In addition, adequate fluid resuscitation is postulated to reduce the incidence of secondary complications such as acute respiratory failure, renal failure, and infection. Of the fluids used presently for the resuscitation of hypotensive trauma victims, however, none has been demonstrated to improve survival or decrease the incidence of secondary complications. Solutions have been approved for other clinical indications and then applied to care of the trauma patient. The absence of validation of the indication of these fluids in patients with traumatic injuries is due to a number of factors, including the heterogeneity of the trauma patient population and the focus on near-term resuscitation endpoints rather than end-points related to clinical outcome.