Preferences of critical care registrars in fluid resuscitation of major trauma patients: Concordance with current guidelines

Abstract

Fluid resuscitation of patients with major trauma remains a controversial topic. We hypothesised that current practice amongst critical care registrars at our centre might differ from current clinical guidelines. Sixty-six registrars from anaesthesia, intensive care and emergency medicine completed a survey giving their preferences for fluid resuscitation in major trauma patients. Most (85%) appropriately would choose a crystalloid (normal saline 68%, Hartmann's solution 17%), although intensive care registrars reported an early preference for colloids (20% of intensive care registrars would choose a colloid vs 0% of other departmental registrars, P <0.01). Many responses indicated that the presence of an acidosis would not influence their choice of primary resuscitation fluid. Few participants were unfamiliar with the current practice of avoiding colloids as a primary resuscitation fluid in head-injured patients. Most (62%) would choose to transfuse trauma patients after 2 litres of crystalloid, although there was significant inter-departmental variation (P <0.01). In addition, participants would transfuse an older patient (P=0.02) or an actively bleeding patient (P <0.01) earlier than the younger or not visibly bleeding trauma patient. We concluded that our study demonstrated general consistency with current clinical guidelines but with interesting interdepartmental variations. We suggest that this type of study could enhance clinical practice by pointing to targeted additional learning opportunities.