title: Volume replacement during trauma resuscitation: a brief synopsis of current guidelines and recommendations.
abstract: BACKGROUND
  Intravascular volume and fluid replacement are still cornerstones to correct fluid deficits during early trauma resuscitation, but optimum strategies remain under debate.
  
  
  METHODS
  A synopsis of best current knowledge with reference to the following guidelines and recommendations is presented: (1) The European Guideline on Management of Major Bleeding and Coagulopathy following Trauma (fourth edition), (2) S3 Guideline on Treatment of Patients with Severe and Multiple Injuries [English Version of the German Guideline S3 Leitlinie Polytrauma/Schwerverletzten-Behandlung/AWMF Register-Nr. 012/019 sponsored by the German Society for Trauma Surgery/Deutsche Gesellschaft für Unfallchirurgie (DGU)], and (3) S3 Guideline Intravascular Volume Treatment in the Adult [AWMF Register-Nr 001/020 sponsored by the German Society for Anesthesiology and Intensive Medicine/Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)].
  
  
  CONCLUSIONS
  Volume replacement at a reduced level in severely injured and bleeding trauma patients is advocated (permissive hypotension) until the bleeding is controlled. ATLS principles with Hb, BE, and/or lactate can assess perfusion, estimate/monitor the extent of bleeding/shock, and guide therapy. Isotonic crystalloid solutions are first-line and specific recommendations apply for patients with TBI.
authors.affiliation: Department for Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke (UW/H), Ostmerheimerstr. 200, 51109, Cologne, Germany. Marc.Maegele@t-online.de.|Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke (UW/H), Campus Cologne-Merheim, Ostmerheimerstr. 200, 51109, Cologne, Germany. Marc.Maegele@t-online.de.
authors.forename: M
authors.initials: M
authors.lastname: Maegele
authors.affiliation: Department for Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke (UW/H), Ostmerheimerstr. 200, 51109, Cologne, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Fröhlich
authors.affiliation: Department for Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke (UW/H), Ostmerheimerstr. 200, 51109, Cologne, Germany.|Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke (UW/H), Campus Cologne-Merheim, Ostmerheimerstr. 200, 51109, Cologne, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Caspers
authors.affiliation: Department for Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke (UW/H), Ostmerheimerstr. 200, 51109, Cologne, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Kaske
mesh_terms: D005440:Fluid Therapy / Q000592:standards*; D006801:Humans; D009104:Multiple Trauma / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012151:Resuscitation
keywords: Bleeding; Hypovolaemia; Shock; Trauma; Volume resuscitation