Fluids

Abstract

It is impossible to imagine daily critical care practice without intravenous fluids, yet as a safe and dependable form of treatment, it is a relatively new phenomenon. The need for fluid administration and its importance has been recognized since ancient times, but the ancients had no recourse to intravenous administration. Fluids of various kinds, particularly blood, have fascinated the medical fraternity for centuries – for both medical and non-medical purposes. The first documented use of blood transfusion was in dogs in 1666 by Richard Lower, and this led to use in man by Jean Baptiste Denis in 1667. He was the physician to Louis XIV, and in his first attempts he used lambs’ blood. This appeared to ‘work’ in the first patient, but then the next two died. The documentation is vague; however, it has been suggested that the cause of the deaths and in particular the issue of incompatibility might have been a major subject of discussion during 1668, but whether this occurred and what the conclusions were are not known. Not surprisingly, the method fell into disrepute. It was then almost 150 years before J. Blundell reported in 1818 on the first successful transfusion of human blood. This was performed at St Thomas Hospital for a parturient. Vein to vein transfusion was described by James Hobson Aveling in 1819, and autotransfusion, introduced in 1874, was in common use at the end of the nineteenth century. At the time of World War I, anesthesiologists such as G.W. Crile began involving themselves in maintaining patients’ hemodynamic status.