Dr. James Shuler
The increasing probability of protracted medical evacuation times in deployed environments has created a fundamental shift in medical doctrine within the military health system. One main shift is the clinical practice guideline of prolonged field care and whole blood transfusion. In previous conflicts of this century, such as Operation Iraqi Freedom and Operation Enduring Freedom, there has been a great disparity in air superiority in favor of coalition forces. This article attempts to evaluate intravascular fluid protocols in critical and non-critical patients. This article reviewed multiple meta-analyses and clinical trials in multiple settings, showing a statistically significant reduction in morbidity and mortality with balanced crystalloids as opposed to normal saline in non-TBI patients. The weaknesses of this article are potential biases, none of the studies were blinded, they all excluded TBI patients, and likely patients in one of the clinical studies received intravascular fluid therapy unnecessarily which potentially confounds safety profile results. The major strength of this article is the inclusion of the SMART, BEST Fluids and PRISMA studies which included very large sample sizes. Appropriate intravascular fluid therapy based on patient physiology is important not only to effective patient care but also in decreasing the healthcare burden to combatant commanders.
Olund GG. Review of intravascular fluid therapy; 0.9% Normal Saline vs. Balanced Crystalloids. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2023; 5(2).
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