CONTEMPORARY APPROACH IN TREATMENT OF HYPOVOLEMIC SHOCK

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.