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BJA Advance Access published online on June 21, 2007
British Journal of Anaesthesia, doi:10.1093/bja/aem165
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Crystalloid infusion rate during fluid resuscitation from acute haemorrhage

T. Tatara*, T. Tsunetoh and C. Tashiro

Department of Anaesthesiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan

* Corresponding author. E-mail: ttatara{at}hyo-med.ac.jp

Background: Information is lacking concerning optimal infusion rates of crystalloid during resuscitation from acute haemorrhage. In this study, a mathematical model was used to predict infusion volume of crystalloid needed to restore and maintain blood volume after acute haemorrhage.

Methods: The scenario was a haemorrhage of 15 ml kg–1 over 30 min in a 70 kg man. A bolus of crystalloid was administered at a rate of 40, 60, 80, 100, or 120 ml kg–1 h–1 until blood volume was restored. Fluid infusion rate needed to maintain blood volume for a further 1 h was computed.

Results: Blood volume was restored earlier at high bolus infusion rates compared with low bolus infusion rates (6 min at 120 ml kg–1 h–1 vs 63 min at 40 ml kg–1 h–1). Fluid infusion rates for blood volume maintenance approached 33 ml kg–1 h–1 irrespective of bolus infusion rates. The restoration fluid volume at 40 ml kg–1 h–1 was 2.9 litre, three times that at 80–120 ml kg–1 h–1. The maintenance fluid volume at 80–120 ml kg–1 h–1 was 2.9 litre, 0.6 litre more than that at 40 ml kg–1 h–1. During the blood volume maintenance, the interstitial volume increased to 3.8 litre above normal at 40 ml kg–1 h–1 and to 2.5 litre at 80–120 ml kg–1 h–1.

Conclusions: Bolus crystalloid infusion exceeding 80 ml kg–1 h–1 may not increase effectiveness of fluid resuscitation. Crystalloid resuscitation for more than 2 h may be detrimental in view of an excessive net fluid retention.

Keywords: blood, loss; blood, volume; fluid balance; fluids, i.v.; model, mathematical


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