Hemodynamic support of the trauma patient.
OBJECTIVE
The aim of this review is to address and summarize some key issues and recent insights into the hemodynamic support of the trauma patient related to fluid administration.


RESULTS
Colloids are not superior to crystalloids in treating hypovolemia in the trauma patient and show no survival benefit. Furthermore, several adverse effects (renal failure, bleeding complications and anaphylaxis) have been reported with the use of artificial colloids. Hypertonic saline is effective and well tolerated in the treatment of hypovolemic shock and traumatic brain injury. Potential benefits are reduced fluid requirements and immune modulation. Resuscitation strategies should depend on the type of injury (penetrating vs. blunt; concomitant brain injury). Excessive fluid resuscitation, which can cause acute respiratory distress syndrome, abdominal compartment syndrome and brain edema, should be avoided. Dynamic parameters to guide volume therapy are probably more reliable than static parameters and minimally invasive techniques to monitor the microcirculation are becoming more important to determine the endpoints of resuscitation.


CONCLUSIONS
Hemodynamic support is an early goal in the treatment of the trauma patient. The use of crystalloids is currently recommended in trauma resuscitation. The amount of fluid we give should be tailored to the individual trauma patient in which clear endpoints of resuscitation are of vital importance to maximize the chances of survival.
van den Elsen
Maarten Jlj
MJ
Department of Intensive Care Medicine, The Netherlands. melsen1@planet.nl
Leenen
Luke Ph
LP
Kesecioglu
Jozef
J
D000818:Animals; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003102:Colloids / Q000627:therapeutic use; D000077324:Crystalloid Solutions; D023381:Endpoint Determination; D006439:Hemodynamics; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D010952:Plasma Substitutes / Q000627:therapeutic use; D012151:Resuscitation; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D014947:Wounds and Injuries / Q000503:physiopathology / Q000628:therapy*
D002316:Cardiotonic Agents; D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D012462:Saline Solution, Hypertonic