New Study Questions Value of Giving IVs to Trauma Patients
WASHINGTON — The universal and barely questioned practice of giving intravenous fluids to bleeding trauma patients in order to raise their blood pressure may be doing more harm than good, according to new research.
This treatment, considered so essential that it often is begun by paramedics on the street or in an ambulance, instead may increase a person’s risk of death by throwing out of kilter the body’s innate response to life-threatening injury.
The study, published in today’s New England Journal of Medicine, could affect virtually every hospital and emergency medical service in the country if confirmed by further research.
Bleeding from lacerated arteries or veins can rapidly deplete the volume of blood in the circulatory system. Blood pressure can then fall, threatening the delivery of oxygen and removal of waste products from vital organs. A sustained state of minimal blood flow is called shock, and can lead to irreversible organ damage and death.
In emergency medical care, the maintenance of blood pressure is considered third only to the initiation of breathing and the establishment of a heartbeat as essential treatment for a trauma patient.
Physicians at Baylor University in Houston and at the University of Oklahoma looked at the effects of “fluid resuscitation” in people who had suffered gun or stab wounds requiring immediate surgery.
Physicians alternated fluid treatment every other day in 598 patients. On even numbered days, incoming patients would get fluids as soon as paramedics or a doctor could start an intravenous line. On odd days, they would have IV lines placed but no fluid started until they got to the operating room.
Among the patients who got “delayed” fluid resuscitation, 70% survived, compared with 62% of the group that got it immediately. The delayed group had a shorter hospital stay--11 days on average, compared to 14 days for the patients who received fluids before surgery. There was also a general trend toward fewer post-operative complications--such as respiratory distress, kidney failure and severe infection--in the delayed group.
The researchers found, as expected, that patients who got IV fluids during the ambulance ride got to the hospital with higher systolic blood pressures than those who got no fluids. The difference was not great, and in both groups was below 80.
Surprisingly, however, the groups had identical systolic blood pressures--about 112--when they arrived in the operating room. This suggests that the members of the delayed group (if they survived that long) were able to re-establish a near-normal pressure through innate mechanisms and without the addition of “volume” in the form of IV fluids.
The researchers hypothesized that IV fluids had a detrimental effect in several ways.
The main one is that higher blood pressures probably tend to dislodge the clot that forms naturally to close the hole in the vessel at the site of bleeding.
