Fluid resuscitation in trauma patients with hemorrhagic shock is controversially discussed in the literature. The coincidence of brain injury complicates management of these patients. This article summarizes the current knowledge on nonblood component fluid resuscitation and choice of fluids in patients with multiple trauma. RECENT FINDINGS: Whereas current evidence suggests the efficacy of fluid therapy in hemorrhagic shock without active bleeding, experimental and clinical data demonstrate that aggressive volume challenge may be futile or even deleterious in the setting of uncontrolled hemorrhage. Large amounts of isotonic crystalloids may be associated with hypothermia, acidosis and inflammation. In patients with traumatic brain injury hypertonic solutions may positively influence inflammation and intracranial pressure without affecting neurologic outcome or mortality. SUMMARY: To date no large-scale clinical studies exist to either support or refute the use of nonblood component fluid resuscitation of hemorrhagic shock in trauma patients. The optimal choice of fluid remains to be determined, but existing evidence suggests avoiding crystalloids in favor of hypertonic solutions. The role of modern, iso-oncotic colloids in the treatment of hemorrhagic shock has not yet been sufficiently defined. In patients with concomitant brain injury, arterial hypotension must be avoided and infusion of hypotonic solutions is obsolete, whereas administration of hypertonic solutions may exert beneficial effects beyond hemodynamic stabilization.

Department of Anesthesiology and Intensive Care University of Muenster Muenster Germany

Fluid resuscitation in multiple trauma patients

Lit.: 68

000      

00000naa 2200000 a 4500

001      

bmc11039407

003      

CZ-PrNML

005      

20111210223334.0

008      

111108s2011 xr e cze||

009      

AR

040    __

$a ABA008 $b cze $c ABA008 $d ABA008 $e AACR2

041    0_

$a cze $b eng

044    __

$a xr

100    1_

$a Ertmer, Christian

245    10

$a Tekutinová resuscitace pacientů s polytraumaty / $c Christian Ertmer, Tim Kampmeier, Sebastian Rehberg, Matthias Lange

246    11

$a Fluid resuscitation in multiple trauma patients

314    __

$a Department of Anesthesiology and Intensive Care, University of Muenster, Muenster, Germany

504    __

$a Lit.: 68

520    9_

$a Fluid resuscitation in trauma patients with hemorrhagic shock is controversially discussed in the literature. The coincidence of brain injury complicates management of these patients. This article summarizes the current knowledge on nonblood component fluid resuscitation and choice of fluids in patients with multiple trauma. RECENT FINDINGS: Whereas current evidence suggests the efficacy of fluid therapy in hemorrhagic shock without active bleeding, experimental and clinical data demonstrate that aggressive volume challenge may be futile or even deleterious in the setting of uncontrolled hemorrhage. Large amounts of isotonic crystalloids may be associated with hypothermia, acidosis and inflammation. In patients with traumatic brain injury hypertonic solutions may positively influence inflammation and intracranial pressure without affecting neurologic outcome or mortality. SUMMARY: To date no large-scale clinical studies exist to either support or refute the use of nonblood component fluid resuscitation of hemorrhagic shock in trauma patients. The optimal choice of fluid remains to be determined, but existing evidence suggests avoiding crystalloids in favor of hypertonic solutions. The role of modern, iso-oncotic colloids in the treatment of hemorrhagic shock has not yet been sufficiently defined. In patients with concomitant brain injury, arterial hypotension must be avoided and infusion of hypotonic solutions is obsolete, whereas administration of hypertonic solutions may exert beneficial effects beyond hemodynamic stabilization.

650    _2

$a poranění mozku $x terapie $7 D001930

650    _2

$a koloidy $x terapeutické užití $7 D003102

650    _2

$a urgentní zdravotnické služby $7 D004632

650    _2

$a tekutinová terapie $7 D005440

650    _2

$a lidé $7 D006801

650    _2

$a hypertonické roztoky $x terapeutické užití $7 D006982

650    _2

$a isotonické roztoky $x terapeutické užití $7 D007552

650    _2

$a polytrauma $x patofyziologie $x terapie $7 D009104

650    _2

$a náhražky plazmy $x terapeutické užití $7 D010952

650    _2

$a resuscitace $x metody $7 D012151

650    _2

$a hemoragický šok $x farmakoterapie $x patofyziologie $x terapie $7 D012771

655    _2

$a přehledy $7 D016454

700    1_

$a Kampmeier, Tim

700    1_

$a Rehberg, Sebastian

700    1_

$a Lange, Matthias

773    0_

$w MED00169418 $t Current opinion in anesthesiology $g Roč. 2, č. 2 (2011), s. 30-36 $x 1804-204X

910    __

$a ABA008 $b B 2620 $c 24 $y 7

990    __

$a 20111108085418 $b ABA008

991    __

$a 20111108091245 $b ABA008

999    __

$a ok $b bmc $g 885570 $s 749723

BAS    __

$a 3

BMC    __

$a 2011 $b 2 $c 2 $d 30-36 $m Current Opinion in Anesthesiology $x MED00169418

LZP    __

$a 2011-22/mkme