Resuscitation fluids in trauma 1: why give fluid and how to give it

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Fluid resuscitation following trauma is necessary to restore compromised organ perfusion and hypoxic tissue damage. The activation of the Systemic Inflammatory Response Syndrome in response to both traumatic and subsequent hypoxic insults has implications for what represents the optimal fluid resuscitation strategy. There is no single resuscitation strategy that can be applied to all patients with traumatic injury. This article reviews the evidence available to help guide fluid therapy. A number of studies have suggested that timing of fluid therapy with respect to surgical intervention is crucial. Prior to definitive treatment of injury permissive hypotension confers advantage, particularly in the setting of penetrating trauma. The situation is less clear in cases of blunt trauma, where further studies comparing restrictive with liberal fluid regimes are required. The site of injury will also influence the strategy to be adopted. Following traumatic brain injury, maintenance of cerebral perfusion pressure is likely to be of overriding importance. Once definitive surgical control of haemorrhage has been achieved, fluid therapy to maximise stroke volume and cardiac output is advised. Following the development of established critical illness, goal-directed therapy may increase mortality.