Recommendation 3.1 Research involving modifications of existing lactated Ringer's solutions could include:

    1.  

    elimination of D-lactate,

    2.  

    reduction of total L-lactate load,

    3.  

    addition of ketones as an energy source, and

    4.  

    addition of free-radical scavengers and antioxidants (vitamins E and C, glutathione, or iron chelators).

    Recommendation 3.2 Studies examining modifications of the existing lactated Ringer's solution formula must include examining the effects of the modified solution on:

      1.  

      immunologic-related function,

      2.  

      cellular apoptosis,

      3.  

      intravascular retention, and

      4.  

      specific end-organ function such as pulmonary, renal, and cardiac function (i.e., the presence or absence of arrhythmias).

      Recommendation 3.3 Previous concerns regarding the detrimental effects of aggressive fluid resuscitation with large volumes of crystalloids suggested the need to examine both the immunologic as well as hemodynamic consequences of small-volume lactated Ringer's resuscitation. Studies examining reduced volume of lactated Ringer's solution should examine the effects of this volume on:

        1.  

        hemodynamic function,

        2.  

        immunologic-related function,

        3.  

        cellular apoptosis, and

        4.  

        specific end-organ function, such as pulmonary, renal, and cardiac function.



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