Intravenous Fluid Therapy Choice in Trauma Patients in the Intensive Care Unit: A Scoping Review.

Abstract

Background: In critically ill patients, intravenous fluid resuscitation is contentious. Although research has explored intravenous fluids for patients with sepsis or septic shock, evidence guiding fluid choices for trauma patients in intensive care units remains scarce.

Objective: To summarize current recommendations for intravenous fluid choices for resuscitation and their impact on outcomes in trauma patients in intensive care units.

Methods: The literature was appraised with a scoping review using the Joanna Briggs Institute framework.

Results: A search of databases (CINAHL Plus, MEDLINE, Health Source: Nursing/Academic Edition, PubMed, and Scopus) yielded 10 articles examining crystalloid and colloid solutions. In trauma patients, major adverse outcomes (mortality, acute kidney injury, hospital/intensive care unit length of stay) did not significantly differ according to crystalloid solution type except in patients with traumatic brain injury, for whom normal saline was beneficial. Albumin and hypertonic saline as adjuncts to fluid therapy were generally safe except for patients with traumatic brain injury.

Discussion: Balanced crystalloid solutions and normal saline can be used interchangeably in trauma patients except those with traumatic brain injury. The use of albumin for first-line resuscitation is questionable due to cost and lack of benefit over other fluids. Hypertonic saline may benefit patients with delayed abdominal closure after exploratory laparotomy.

Conclusion: In trauma patients, outcomes are not influenced by intravenous fluid type except for those with traumatic brain injury, for whom normal saline is preferred over balanced crystalloid solutions. Hypertonic saline and albumin may be adjunct therapies after considering cost, availability, and individual patient characteristics.