Volume replacement during trauma resuscitation: a brief synopsis of current guidelines and recommendations

Intravascular volume and fluid replacement are still cornerstones to correct fluid deficits during early trauma resuscitation, but optimum strategies remain under debate.

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)].

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.