Volume therapy in hypotensive trauma patients

In trauma patients it is mandatory to establish the exact reason for their hypotension. If hypovolaemia is most probably responsible for the hypotensi on, fluid resuscitation should be initiated. The therapy of choice is infus ion of sugarless, isotonic crystalloids with a physiologic serum electrolyt e composition. In patients with brain injuries a decrease in serum osmolali ty is not advisable and hypertonic fluids may therefore be considered. Huma n albumin preparations are no longer indicated, but synthetic colloids may be an adjunct to a pure crystalloid regime. Hydroxyethyl starch preparation s with a molecular weight in the mean range are reasonable choices consider ing the individual advantages and disadvantages of the various colloids. La rger blood losses must be treated with blood components such as packed red cells, fresh frozen plasma and thrombocyte concentrates as indicated. There are no widely accepted values for laboratory or monitoring parameters in s tarting or stopping a given fluid therapy; these values are unquestionably influenced, among other things, by the patient history and the pattern of t he injuries. Initial resuscitation (when to start, who should administer th e fluid and how much) also remains a focus of heated controversy.