Crystalloid infusion rate during fluid resuscitation from acute haemorrhage

Information is lacking concerning optimal infusion rates of crystalloid during resuscitation from acute haemorrhage. In this study, a mathematical model was used to predict infusion volume of crystalloid needed to restore and maintain blood volume after acute haemorrhage.

The scenario was a haemorrhage of 15 ml kg(-1) over 30 min in a 70 kg man. A bolus of crystalloid was administered at a rate of 40, 60, 80, 100, or 120 ml kg(-1) h(-1) until blood volume was restored. Fluid infusion rate needed to maintain blood volume for a further 1 h was computed.

Blood volume was restored earlier at high bolus infusion rates compared with low bolus infusion rates (6 min at 120 ml kg(-1) h(-1) vs 63 min at 40 ml kg(-1) h(-1)). Fluid infusion rates for blood volume maintenance approached 33 ml kg(-1) h(-1) irrespective of bolus infusion rates. The restoration fluid volume at 40 ml kg(-1) h(-1) was 2.9 litre, three times that at 80-120 ml kg(-1) h(-1). The maintenance fluid volume at 80-120 ml kg(-1) h(-1) was 2.9 litre, 0.6 litre more than that at 40 ml kg(-1) h(-1). During the blood volume maintenance, the interstitial volume increased to 3.8 litre above normal at 40 ml kg(-1) h(-1) and to 2.5 litre at 80-120 ml kg(-1) h(-1).

Bolus crystalloid infusion exceeding 80 ml kg(-1) h(-1) may not increase effectiveness of fluid resuscitation. Crystalloid resuscitation for more than 2 h may be detrimental in view of an excessive net fluid retention.