What Are the Goals of Resuscitation in the ED? What Intravenous Fluids Should Be Used? Are Vasopressors Beneficial or Harmful? Should Antibiotics Be Administered?

Abstract

Goals of resuscitation in the emergency department for patients with confirmed or suspected acute mesenteric ischemia (AMI) are to preserve perfusion, minimize ischemic tissue, and prevent development of sepsis or multiorgan failure. Because the downstream effects of ischemia include decreased oxygen delivery to hypo-perfused tissues resulting in lactate accumulation and acidemia, fluid resuscitation with crystalloid fluids should be initiated as soon as AMI is suspected. There is no benefit to resuscitation with colloid fluids over crystalloid fluids. Vasopressors should be used with caution, but if indicated, norepinephrine alone or in combination with dobutamine is recommended. Antibiotic coverage should be initiated early and cover both Gram-negative and anaerobic bacteria.