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Mon Sep 26 14:19:33 BST 2011

Norman

Professor, Tulane University, Surgery
Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO
New Orleans, Louisiana
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Pradeep Navsaria
Sent: Monday, September 26, 2011 8:02 AM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: trauma ressuscitation

Trauma Center
Cape Town
>>> "McSwain, Norman E" <nmcswai at tulane.edu> 2011/09/26 02:45 PM >>>
I can't get access to this study without joining. What does it say
regarding final outcome, blood loss changes, and othr complications?

Norman

Professor, Tulane University, Surgery
Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO New Orleans,
Louisiana
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Pradeep Navsaria
Sent: Monday, September 26, 2011 6:35 AM
Cc: Trauma-List [TRAUMA.ORG]
Subject: Re: trauma ressuscitation

Maybe of interest.

Resuscitation with hydroxyethyl starch improves renal function and
lactate clearance in penetrating trauma in a randomized controlled
study: the FIRST trial (Fluids in Resuscitation of Severe Trauma).

http://bja.oxfordjournals.org/content/early/2011/08/19/bja.aer229.long

Trauma Center
Cape Town
>>> Ian Seppelt <seppelt at med.usyd.edu.au> 2011/09/26 12:21 PM >>>
SAFE of course included over 1000 trauma patients in an RCT of saline vs
albumin for fluid resuscitation (conclusion - worse outcome using
albumin in the trauma cohort, which turned out to be the traumatic brain
injury group if subsequent analysis and followup).

There is a similar 7000 patient RCT of saline vs 125/0.4 HES (Voluven)
underway at present, similarly expecting about 1000 trauma patients as
one predefined cohort.

Ian

Sent from my iPad

On 25/09/2011, at 11:07 PM, "McSwain, Norman E" <nmcswai at tulane.edu>
wrote:

> Most of the data with Hextend and similar compounds have NOT shown
any
> outcome differences. However there have been no randomized
prospective
> studies. The major studies have come out of Miami and are only 
> comparisons of some surgeons who used and other who did not. These 
> studies are not good comparisons and cannot be used to comment on
the
> outcome. 
> 
> Because of the research rules of informed consent such RP studies
are
> very hard to do in the US. Someone who does not have these
limitations
> should do a good RP study
> 
> The benefit for the military is that these colloids are much lighter
to
> carry and require less space (500cc vs 1000 cc). That provides a 
> significant difference when on a mission.
> 
> Bottom line. Colloids like Hextend should reduce the edema problems
of
> crystalloid use but no one knows for sure so the best management is 
> probably plasma and RBC with no crystalloid or colloids
> 
> Norman
> 
> Professor, Tulane University, Surgery
> Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO New 
> Orleans, Louisiana
> 504 988 5111
> 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of rm khattar
> Sent: Sunday, September 25, 2011 7:45 AM
> To: trauma-list at trauma.org
> Subject: trauma ressuscitation
> 
> I have read so much in last few years on this list about permissive 
> hypotension,role of crystalloids etc.
> Kindly educate me regarding, place of plasma expanders in trauma 
> resuscitation,[Hypovolemic shock]and septic shock.
> Thanks
> R.M.Khattar
> Delhi India.
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