title: Fluid resuscitation and vasopressors in severe trauma patients.
abstract: OBJECTIVE
  To discuss the fluid resuscitation and the vasopressor support in severe trauma patients.
  
  
  RESULTS
  A critical point is to prevent a potential increase in bleeding by an overly aggressive resuscitative strategy. Indeed, large-volume fluid replacement may promote coagulopathy by diluting coagulation factors. Moreover, an excessive level of mean arterial pressure may induce bleeding by preventing clot formation.
  
  
  CONCLUSIONS
  Fluid resuscitation is the first-line therapy to restore intravascular volume and to prevent cardiac arrest. Thus, fluid resuscitation before bleeding control must be limited to the bare minimum to maintain arterial pressure to minimize dilution of coagulation factors and complications of over fluid resuscitation. However, a strategy of low fluid resuscitation needs to be handled in a flexible way and to be balanced considering the severity of the hemorrhage and the transport time. A target systolic arterial pressure of 80-90 mmHg is recommended until the control of hemorrhage in trauma patients without brain injury. In addition to fluid resuscitation, early vasopressor support may be required to restore arterial pressure and prevent excessive fluid resuscitation. It is crucial to find the best alchemy between fluid resuscitation and vasopressors, to consider hemodynamic monitoring and to establish trauma resuscitative protocols.
authors.affiliation: aAP-HP, Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre bLaboratoire d'Etude de la Microcirculation, 'Bio-CANVAS: Biomarkers in Cardio-Neurovascular Diseases' UMRS 942, Paris, France.
authors.forename: Anatole
authors.initials: A
authors.lastname: Harrois
authors.forename: Sophie Rym
authors.initials: SR
authors.lastname: Hamada
authors.forename: Jacques
authors.initials: J
authors.lastname: Duranteau
mesh_terms: D001794:Blood Pressure; D005440:Fluid Therapy; D006470:Hemorrhage / Q000628:therapy; D006801:Humans; D012151:Resuscitation / Q000379:methods; D015599:Trauma Severity Indices; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*; D014947:Wounds and Injuries / Q000188:drug therapy / Q000628:therapy*
chemical_list: D014662:Vasoconstrictor Agents