Krishtafor D. Qualitative and quantitative correction of blood replacement in multiple trauma

Dissertation is devoted to reasoning, research and introduction to the clinical practice of optimal variants of resuscitation in acute massive traumatic blood loss. The study is based on the analysis of post-traumatic period and outcomes in 122 multiple trauma victims with a blood loss from 30 % to 60 % of circulating blood volume divided into three groups, depending on fluid resuscitation type. We used clinical, instrumental, laboratory and calculation methods. We discovered that multiple trauma with loss of 30 % to 60 % circulating blood volume forms multiple organ dysfunction syndrome with cerebral, respiratory, gastrointestinal, hepatic, renal, coagulation dysfunction and cardiovascular insufficiency, along with significant inflammatory response. The traditional (liberal) type of fluid resuscitation effectively restores hemodynamics in early posttraumatic period, but prolongs existing multiple organ dysfunction and leads to a high complications and mortality rate. Reduction of total infusion volume allows to form a hyperdynamic type of blood circulation up to 3 days from admission, accelerate reversion of metabolic acidosis, cytolytic syndrome, reduce inflammation, prevent the development of dilutional coagulopathy, accelerate restoration of central nervous system, kidneys, lungs and gastrointestinal tract. Adding a combined solution of L-arginine and L-carnitine into therapy allows to further reduce inflammation and time of MODS regression.