The hemodynamic response to the initial fluid infusion falls into one of three categories. A small number of patients will respond to the initial fluid bolus with a prompt normalization of blood pressure and will maintain hemodynamic stability.
Further therapy is directed at replacing ongoing losses.
The majority of patients will show a transient response to the fluid bolus. Over time, the initial improvement dissipates, requiring further administration of volume to restore and maintain hemodynamic stability. The third category consists of that small number of patients who show minimal or no response to fluid boluses and usually have an exsanguinating hemorrhage, requiring immediate surgical control. The clinical picture of this subset of patients may be compounded by myocardial dysfunction, necessitating invasive assessment of volume status and myocardial function. The goal in blood transfusion is to optimize oxygen delivery to the cells.