Abstract
Purpose
Volume replacement regimens are discussed very emotionally. Interpretation of the literature is difficult due to variations in study design, patient population, target for volume replacement, endpoints, and type of fluids. Meta-analyses may not be very helpful because all kinds of patients and very old studies are included. The principles and options for volume replacement were reviewed exclusively in trauma patients and studies from the literature focusing on this problem were analyzed.
Source
Using a MEDLINE search, volume replacement therapy in adult trauma patients published in the English language from 1985 to the end of 2002 were identified and analyzed. Studies on prehospital volume replacement, volume replacement in the emergency area or in the operating room, and volume therapy in trauma intensive care unit patients were included.
Principle findings
The age-old crystalloid/colloid controvery has still not been resolved but has been enlarged to a colloid/colloid debate. It is now widely accepted that human albumin could easily be replaced by synthetic colloids for volume replacement in trauma patients. No superiority of a specific volume replacement strategy with regard to outcome was found. However, in several studies outcome was not the major endpoint. Although showing some promising results, the importance of hypertonic solutions for volume replacement in the trauma patient is not yet defined.
Conclusion
The choice of fluid therapy in trauma patients engenders the most controversy and an examination of the body of literature on this subject results in confusion. It is imperative to continue the search for substances that are effective in avoiding the development of post-trauma multi-organ dysfunction syndrome without detrimental side-effects.
Résumé
Objectif
Les doses de remplissage vasculaire suscitent des discussions très émotives. L’interprétation des publications est difficile à cause de la diversité des devis d’études, des populations de patients, des cibles de remplissage vasculaire, des paramètres étudiés et des types de liquides. Les méta- analyses ne sont peut- être pas très utiles parce qu’elles comprennent tous les types de patients et d’anciennes études. Les principes qui régissent le remplissage vasculaire et les options offertes ont été revus exclusivement chez les polytraumatisés et les études qui mettent l’accent sur ce problème ont été analysées.
Source
Les articles sur le remplissage vasculaire réalisé chez les patients polytraumatisés et rapportés en anglais entre 1985 et la fin de 2002 ont été repérés dans MEDLINE et analysés. Les études sur le remplissage vasculaire préhospitalier, sur le remplissage vasculaire à l’urgence ou en salle d’opération et sur le remplissage vasculaire chez les patients polytraumatisés de l’unité des soins intensifs ont été retenues.
Constatations principales
La sempiternelle controverse cristalloïde/colloïde n’est pas encore résolue, et s’est étendue au débat colloïde/colloïde. On accepte généralement de remplacer l’albumine humaine par des colloïdes synthétiques chez les polytraumatisés. Nous n’avons trouvé aucune stratégie de remplissage vasculaire qui soit supérieure aux autres quant au résultat. De toute manière, le résultat n’était pas toujours le paramètre principal. Même si les solutions hypertoniques ont présenté quelques résultats prometteurs, leur importance dans le remplissage vasculaire chez les polytraumatisés n’est pas encore définie.
Conclusion
Le choix d’une fuidothérapie chez les polytraumatisés engendre la plus grande controverse. L’examen des publications sur le sujet n’apporte que confusion. Il faut poursuivre la recherche de substances efficaces, qui n’occasionnent pas de déficiences polyviscérales post- traumatiques et qui soient sans effets secondaires nocifs.
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Change history
17 November 2021
This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1007/s12630-021-02125-9
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Boldt, J. RETRACTED ARTICLE: Fluid choice for resuscitation of the trauma patient: a review of the physiological, pharmacological, and clinical evidence. Can J Anesth/J Can Anesth 51, 500–513 (2004). https://doi.org/10.1007/BF03018316
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DOI: https://doi.org/10.1007/BF03018316