CURRENT ASPECTS OF FLUID RESUSCITATION IN TRAUMA PATIENTS
DOI:
https://doi.org/10.56238/ERR01v10n7-055Keywords:
Multiple Trauma, Hemorrhagic Shock, HypovolemiaAbstract
Introduction: Hemorrhage is one of the leading preventable causes of death in polytrauma patients, making fluid resuscitation a critical component in the management of hemorrhagic shock. Traditional strategies using large volumes of crystalloids have been questioned due to the risks of coagulopathy, hypothermia, and organ dysfunction. New approaches, such as permissive hypotension, early use of blood products, and adjuvant therapies—like BTK inhibitors and conjugated steroids—have shown promising results. This article discusses recent advances and ongoing challenges in fluid resuscitation in trauma, based on experimental and clinical evidence.
Objective: To analyze the current advances and challenges of fluid resuscitation in trauma patients, with a focus on evidence-based strategies aimed at improving clinical outcomes.
Methodology: This study is an integrative literature review conducted in stages, including topic definition, inclusion and exclusion criteria, selection of descriptors, and article screening and evaluation. The guiding question was: “What are the current aspects of fluid resuscitation in trauma patients?” Searches were performed in the BVS and LILACS databases using the descriptors “multiple trauma,” “shock hemorrhagic,” and “hypovolemia,” combined with the Boolean operators “AND” and “OR.” Inclusion criteria were full scientific articles, in Portuguese or English, published between 2020 and 2025. Excluded were non-scientific and unavailable texts. Of the 4,930 articles found, 63 were selected for the review.
Results: The results show that excessive use of 0.9% saline is associated with hyperchloremia, acidosis, kidney injury, and increased mortality, especially in children with severe trauma. Strategies such as permissive hypovolemia proved effective in reducing mortality and complications. In addition, early interventions, such as the use of type O whole blood and monitoring with ROTEM, contributed to better outcomes. At the molecular level, changes in ADORA3, NOS3, and extracellular vesicles suggest good prognostic value. Thus, individualized fluid resuscitation stands out as an essential approach to optimize clinical outcomes.
Conclusion: Fluid resuscitation in trauma patients should follow an integrated, individualized, and evidence-based approach. Proper selection of fluid type and volume, early administration of blood products, use of strategies such as hypotensive resuscitation, and implementation of balanced solutions contribute to improved clinical outcomes. Moreover, the use of biomarkers and adjuvant therapies, such as BTK inhibitors and conjugated steroids, points to a more precise and effective therapeutic future. The implementation of these practices requires well-structured protocols, trained teams, and adequate resources, both in pre-hospital and hospital settings, aiming to reduce mortality and improve the quality of care for polytrauma patients.
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