[Volume therapy in hypotensive trauma patients].

Area of Science:

• Emergency Medicine
• Trauma Care
• Critical Care

Context:

• Hypotension is a critical concern in trauma patients, necessitating prompt identification of its cause.
• Fluid resuscitation is a cornerstone of managing hypotensive trauma patients, particularly when hypovolemia is suspected.

Purpose:

• To outline evidence-based fluid resuscitation strategies for hypotensive trauma patients.
• To discuss the appropriate use of crystalloids, colloids, and blood products in trauma resuscitation.
• To highlight considerations for fluid therapy in patients with traumatic brain injury.

Summary:

• Isotonic crystalloids with physiological electrolyte composition are the first-line therapy for hypovolemic hypotension.
• Hypertonic fluids may be considered in patients with brain injuries to avoid decreased serum osmolality.
• Synthetic colloids like hydroxyethyl starch can supplement crystalloid therapy, while human albumin is no longer indicated.
• Significant blood loss requires treatment with blood components, including packed red cells, fresh frozen plasma, and thrombocyte concentrates.
• Establishing definitive parameters for initiating or ceasing fluid therapy remains challenging due to patient-specific factors and injury patterns.

Impact:

• Provides guidance for optimizing fluid management in trauma resuscitation.
• Aids clinicians in selecting appropriate resuscitation fluids based on patient condition and injury type.
• Highlights ongoing controversies in trauma resuscitation to encourage further research and clinical consensus.