Coppola Silvia, Froio Sara, Chiumello Davide
Dipartimento di Anestesia Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
Curr Opin Crit Care. 2014 Aug;20(4):444-50. doi: 10.1097/MCC.0000000000000115.
Fluid resuscitation in trauma patients could reduce organ failure, until blood components are available and hemorrhage is controlled. However, the ideal fluid resuscitation strategy in trauma patients remains a debated topic. Different types of trauma can require different types of fluids and different volume of infusion.
There are few randomized controlled trials investigating the efficacy of fluids in trauma patients. There is no evidence that any type of fluids can improve short-term and long-term outcome in these patients. The main clinical evidence emphasizes that a restrictive fluid resuscitation before surgery improves outcome in patients with penetrating trauma. Fluid management of blunt trauma patients, in particular with coexisting brain injury, remains unclear.
In order to focus on the state of the art about this topic, we review the current literature and guidelines. Recent studies have underlined that the correct fluid resuscitation strategy can depend on the type of trauma condition: penetrating, blunt, brain injury or a combination of them. Of course, further studies are needed to investigate the impact of a specific fluid strategy on different type and severity of trauma.
在创伤患者获得血液成分并控制出血之前，液体复苏可减少器官衰竭。然而，创伤患者理想的液体复苏策略仍是一个有争议的话题。不同类型的创伤可能需要不同类型的液体和不同的输注量。
很少有随机对照试验研究液体对创伤患者的疗效。没有证据表明任何类型的液体能改善这些患者的短期和长期预后。主要临床证据强调，手术前进行限制性液体复苏可改善穿透性创伤患者的预后。钝性创伤患者，尤其是伴有脑损伤的患者的液体管理仍不明确。
为了关注该主题的最新进展，我们回顾了当前的文献和指南。最近的研究强调，正确的液体复苏策略可能取决于创伤情况的类型：穿透性、钝性、脑损伤或它们的组合。当然，还需要进一步研究来调查特定液体策略对不同类型和严重程度创伤的影响。
