CONTEMPORARY APPROACH IN TREATMENT OF HYPOVOLEMIC SHOCK
Journal
Macedonian Journal of Anaesthesia
Date Issued
2023-12
Author(s)
Abstract
Acute circulatory failure or shock, regardless the etiology, is a life‐threatening condition that
needs prompt and adequate treatment, as it may progress to organ failure and death. Aggressive
treatment of shocked patients must be early and appropriate in order to prevent or limit vital
organ injury. Fluid resuscitation with vasopressor coadministration is the first line strategy in the
first few hours when treating patients with shock. In bleeding patients with hypovolemic shock,
fluid resuscitation and volume restoration are the mainstay of therapy. Giving 1.5L balanced
fluids in the first hour and an antifibrinolytic in the first 3 hours after the injury is crucial for
preventing tissue damage because of hypovolemia. Crystalloids should be used judiciously
until blood products are ready for use with a rate of 1:1:1. Because no human studies exist to
support the routine use of vasopressors in the trauma setting, in order to avoid further tissue
hypoperfusion and hypoxia due to vasoconstriction, adequate fluid resuscitation should be a
priority. Significant benefits of permissive hypotension resuscitation in terms of reduction of
mortality due to exsanguination after traumatic hemorrhage were reported. In non-bleeding
patients with hypovolemic shock when fluid resuscitation is insufficient adding a vasopressor
is recommended. According to the guidelines for treatment of shock, Norepinephrine is the
first-choice vasopressor in patients with hypovolemic shock, but when the resuscitation with
fluids and vasopressors as a first line strategy is failing, an inotrope should be added to support
the failing circulatory system. Recent recommendations for management of shock are strongly
against the routine use of inotropes as a first line therapy in patients with hypovolemic shock,
but when it comes to usage of inotropes as a rescue therapy dobutamine is the drug of choice.
needs prompt and adequate treatment, as it may progress to organ failure and death. Aggressive
treatment of shocked patients must be early and appropriate in order to prevent or limit vital
organ injury. Fluid resuscitation with vasopressor coadministration is the first line strategy in the
first few hours when treating patients with shock. In bleeding patients with hypovolemic shock,
fluid resuscitation and volume restoration are the mainstay of therapy. Giving 1.5L balanced
fluids in the first hour and an antifibrinolytic in the first 3 hours after the injury is crucial for
preventing tissue damage because of hypovolemia. Crystalloids should be used judiciously
until blood products are ready for use with a rate of 1:1:1. Because no human studies exist to
support the routine use of vasopressors in the trauma setting, in order to avoid further tissue
hypoperfusion and hypoxia due to vasoconstriction, adequate fluid resuscitation should be a
priority. Significant benefits of permissive hypotension resuscitation in terms of reduction of
mortality due to exsanguination after traumatic hemorrhage were reported. In non-bleeding
patients with hypovolemic shock when fluid resuscitation is insufficient adding a vasopressor
is recommended. According to the guidelines for treatment of shock, Norepinephrine is the
first-choice vasopressor in patients with hypovolemic shock, but when the resuscitation with
fluids and vasopressors as a first line strategy is failing, an inotrope should be added to support
the failing circulatory system. Recent recommendations for management of shock are strongly
against the routine use of inotropes as a first line therapy in patients with hypovolemic shock,
but when it comes to usage of inotropes as a rescue therapy dobutamine is the drug of choice.
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