Benefits of Fluid Therapy on the Hemostatic System of Intensive Care Patients

Review Article

Benefits of Fluid Therapy on the Hemostatic System of Intensive Care Patients

A Sibylle Kozek‐Langenecker
Affiliations: Department of Anesthesiology, General Intensive Care and Pain Management, Vienna Medical University


ABSTRACT

Intensive care patients may have various coagulopathies depending on the underlying disease. Two diametrical derangements of the hemostatic system may be present and evolve during illness: hypocoagulability and hypercoagulability. These extremes may lead to clinical bleeding, multiple organ failure, or thromboembolism. The present article will focus on critically ill patients with the need for fluid therapy and volume expansion such as in sepsis, trauma, and postoperatively after major surgery. In this group of critically ill patients, fluid therapy is required to restore and maintain intravascular volume, to stabilize hemodynamic conditions, and to improve tissue perfusion. Clinical management always needs to balance benefits against potential risks. Efficacy and safety of various crystalloidal and colloidal fluids has been the subject of controversy for years. Depending on the actual status of the hemostatic system, unspecific hemodilution, specific anticoagulant, and/or antiplatelet side‐effects of fluids may be beneficial by mitigating hypercoagulability or may be harmful by aggravating hypocoagulability. This article reviews the coagulation status of anesthesiological intensive care patients, means of point‐of‐care laboratory monitoring, as well as side‐effects of fluids on coagulation and their potential extrapolated benefits. This article may trigger further clinical outcome studies testing the hypothesis that differential indication of fluids decreases coagulopathy, morbidity, and mortality in the high‐risk group of critically ill patients.

Keywords: hydroxyethyl starch, platelet function, coagulation factors, fibrin polymerization, hypercoagulability, sepsis‐associated coagulopathy
Correspondence: Sibylle A Kozek‐Langenecker, Department of Anesthesiology, General Intensive Care and Pain Management, Vienna Medical University, Währinger Gürtel 18–20, 1090‐Vienna, Austria; Department of Anaesthesia and Intensive Care, Evangelisches Krankenhaus Wien, Hans Sachs‐Gasse 10–12, 1180‐Vienna, Austria. E‐mail: sibylle.kozek@meduniwien.ac.at