title: [Volume therapy in the severely injured patient : Recommendations and current guidelines].
abstract: BACKGROUND
  Volume therapy is a cornerstone of early resuscitation of severely injured trauma patients, but the optimal strategy remains under debate. A recent Cochrane review could not find evidence for or against early volume replacement or large versus small amounts of fluid.
  
  
  METHODS
  Current recommendations and guidelines regarding volume therapy in severely injured patients are summarized based upon the updated European Trauma Guideline on the management of major bleeding and coagulopathy following trauma (fourth edition) and the S3-Guideline Polytrauma and combined with a selective review of the literature.
  
  
  CONCLUSIONS
  Current guidelines and recommendations advocate the initiation of volume replacement at a reduced level in bleeding and hypotensive trauma patients in terms of "permissive hypotension," with the aim of maintaining mean arterial blood pressure (MAP) at 65 mm Hg and/or target systolic blood pressure at 80-90 mm Hg so as not to exacerbate the bleeding until its source can be controlled. Advanced Trauma Life Support principles, together with independent measurements of hemoglobin, base excess, and/or lactate, are recommended as sensitive tests for assessing the extent of bleeding and shock. Isotonic crystalloid solutions should be used as first-line volume replacement in bleeding, hypotensive trauma patients. Specific recommendations apply for patients with traumatic brain injury.
authors.affiliation: Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Krankenhaus Köln-Merheim, Lehrstuhl für Unfallchirurgie und Orthopädie, Universität Witten/Herdecke (UW/H), Campus Köln Merheim, Ostmerheimerstr.200, 51109, Köln, Deutschland. sigune.kaske@web.de.
authors.forename: Sigune
authors.initials: S
authors.lastname: Kaske
authors.affiliation: Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Krankenhaus Köln-Merheim, Lehrstuhl für Unfallchirurgie und Orthopädie, Universität Witten/Herdecke (UW/H), Campus Köln Merheim, Ostmerheimerstr.200, 51109, Köln, Deutschland.|Institut für Forschung in der operativen Medizin (IFOM), Universität Witten/Herdecke (UW/H), Campus Köln-Merheim, Ostmerheimerstr. 200, 51109, Köln, Deutschland.
authors.forename: Marc
authors.initials: M
authors.lastname: Maegele
mesh_terms: D004632:Emergency Medical Services / Q000592:standards; D019317:Evidence-Based Medicine / Q000592:standards; D005440:Fluid Therapy / Q000592:standards*; D005858:Germany; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D007022:Hypotension / Q000628:therapy*; D017410:Practice Guidelines as Topic; D014194:Traumatology / Q000592:standards*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy*
keywords: Adults; Bleeding; Severe injury; Trauma; Volume replacement