Hemodynamic support of the trauma patient

作者：van den Elsen Maarten J L J^*; Leenen Luke P H; Kesecioglu Jozef

来源：Current Opinion in Anaesthesiology, 2010, 23(2): 269-275.

DOI：10.1097/ACO.0b013e328336b8d0

• colloids
• crystalloids
• endpoints of resuscitation
• fluids
• hemorrhagic shock
• hypertonic saline
• inotropes
• trauma
• traumatic brain injury
• vasopressors

Purpose of review
The aim of this review is to address and summarize some key issues and recent insights into the hemodynamic support of the trauma patient related to fluid administration.
Recent findings
Colloids are not superior to crystalloids in treating hypovolemia in the trauma patient and show no survival benefit. Furthermore, several adverse effects (renal failure, bleeding complications and anaphylaxis) have been reported with the use of artificial colloids. Hypertonic saline is effective and well tolerated in the treatment of hypovolemic shock and traumatic brain injury. Potential benefits are reduced fluid requirements and immune modulation. Resuscitation strategies should depend on the type of injury (penetrating vs. blunt; concomitant brain injury). Excessive fluid resuscitation, which can cause acute respiratory distress syndrome, abdominal compartment syndrome and brain edema, should be avoided. Dynamic parameters to guide volume therapy are probably more reliable than static parameters and minimally invasive techniques to monitor the microcirculation are becoming more important to determine the endpoints of resuscitation.
Summary
Hemodynamic support is an early goal in the treatment of the trauma patient. The use of crystalloids is currently recommended in trauma resuscitation. The amount of fluid we give should be tailored to the individual trauma patient in which clear endpoints of resuscitation are of vital importance to maximize the chances of survival.

• 出版日期2010-4