ICU · Resuscitation

The Principles of Resuscitation

Also known as Resuscitation · Fluid resuscitation · Fluid responsiveness · Oxygen delivery · Goals of resuscitation · Early goal-directed therapy · Massive transfusion

Resuscitation is the restoration of oxygen delivery to the tissues in the patient in shock, and it is the first act of intensive care. This topic builds the examiner's framework on five ideas. First, the goal — the global oxygen delivery and the perfusion, and the principle that resuscitation targets the perfusion, not a single pressure. Second, fluid — when to give it (only the fluid-responsive patient benefits), how to judge responsiveness (the dynamic indices, the passive leg raise), and the choice of fluid (balanced crystalloids over saline; colloids offer no outcome advantage). Third, blood — the restrictive transfusion threshold and the damage-control ratio in massive haemorrhage. Fourth, the endpoints of resuscitation — the lactate clearance and the peripheral perfusion (the capillary refill), not the central venous pressure. Fifth, the evidence — the EGDT era and its refinement by ProCESS and ARISE, the ANDROMEDA-SHOCK capillary-refill strategy, and the shift from protocolised targets to individualised, perfusion-directed resuscitation.