Inflammation and the Host Response to Injury, a large-scale collaborative project: patient-oriented research core--standard operating procedures for clinical care. III. Guidelines for shock resuscitation.

Shock frequently accompanies severe trauma. In addition to acute mortality, shock is a predominant risk factor for multiple organ dysfunction syndrome (MODS) and shock resuscitation is an obligatory early intervention. Because both under and over resuscitation contribute to the pathogenesis of MODS, the potential for MODS development can be minimized by developing a guideline to insure early consistent and appropriate resuscitative efforts. The challenges of this guideline include: a) early identification of high risk patients, b) implementation in environments that are suboptimal for monitoring resuscitation, c) early identification of resuscitation “non-responders” that require more aggressive interventions, and d) avoiding potentially harmful over zealous interventions. This guideline is based on the best available evidence and expert consensus discussions supported by the Inflammation and Host Response to Injury Large Scale Collaborative Project award from the National Institute of General Medical Sciences, and is being used in the funded clinical studies. The following section provides a brief overview of the rationale for specific guideline recommendations. This is followed by two algorithms that depict escalation in interventions and monitoring requirements in the subset of patients who do not respond to ongoing volume loading and/or blood transfusions. With multi institutional experience and critical analysis this resuscitation process may be further refined; at this time it is intended to serve as a template for interventional trials and to test the utility of new monitoring technology. This protocol was designed for blunt trauma patients who are presumed not to have a serious concomitant brain injury. Its purpose is to guide resuscitation as soon as feasible after arrival in the Emergency Department (ED) after control of active torso bleeding.