title: Fluid resuscitation in multiple trauma patients.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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 In patients with concomitant brain injury, arterial hypotension must be avoided and infusion of hypotonic solutions is obsolete, whereas administration of hypertonic solutions may exert beneficial effects beyond hemodynamic stabilization.
authors.affiliation: Department of Anesthesiology and Intensive Care, University of Muenster, Muenster, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ertmer
authors.forename: Tim
authors.initials: T
authors.lastname: Kampmeier
authors.forename: Sebastian
authors.initials: S
authors.lastname: Rehberg
authors.forename: Matthias
authors.initials: M
authors.lastname: Lange
mesh_terms: D001930:Brain Injuries / Q000628:therapy; D003102:Colloids / Q000627:therapeutic use; D000077324:Crystalloid Solutions; D004632:Emergency Medical Services; D005440:Fluid Therapy; D006801:Humans; D006982:Hypertonic Solutions / Q000627:therapeutic use; D007552:Isotonic Solutions / Q000627:therapeutic use; D009104:Multiple Trauma / Q000503:physiopathology / Q000628:therapy*; D010952:Plasma Substitutes / Q000627:therapeutic use; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy
chemical_list: D003102:Colloids; D000077324:Crystalloid Solutions; D006982:Hypertonic Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes