Fluid resuscitation: a Defence Medical Services Delphi study into current practice.

Area of Science:

• Emergency Medicine
• Critical Care Medicine
• Trauma Management

Background:

• Fluid resuscitation is a cornerstone of emergency and critical care.
• Evolving clinical practices necessitate regular reviews of resuscitation guidelines.
• Understanding current expert consensus is vital for optimizing patient outcomes.

Purpose of the Study:

• To investigate recent changes and expert consensus on fluid resuscitation strategies.
• To identify key areas of agreement and disagreement among medical professionals regarding fluid therapy.

Main Methods:

• A two-round Delphi study involving a 30-member expert panel.
• Panel members were drawn from UK Defence Medical Services, other NATO members, and civilian practice.
• Consensus was sought on various statements related to fluid resuscitation.

Main Results:

• Consensus achieved on the use of adult intraosseous access for resuscitation.
• Agreement reached on the principles of limited hypotensive resuscitation in trauma.
• Consensus supported the implementation of goal-directed therapy for trauma patients.
• No consensus was achieved regarding the choice of non-oxygen carrying synthetic colloids.

Conclusions:

• The study highlights areas of expert agreement in modern fluid resuscitation, particularly for trauma.
• Expert opinion remains divided on the optimal selection of certain synthetic colloids.
• Findings contribute to the ongoing discourse and refinement of fluid resuscitation protocols.