الفهرس 
Pathophysiology of PolytraumaOnly 14 pages are availabe for public view
 |  | from | 114 |  |  |
| | | from | 114 | | |
Abstract
V
olume deficits are often present in trauma patients and may result in the development of posttrauma multiple organ failure in the intensive care unit (ICU). In addition to apparent blood loss, fluid deficits may also occur secondary to generalized alterations of the endothelial barrier, resulting in diffuse capillary leakage and fluid shift from the intravascular to the interstitial compartment.
Adequate volume therapy appears to be fundamental in the management of the trauma patient.
There is still no consensus regarding the optimal treatment of hypovolemia in trauma patients.
Continued controversy exists with regard to the most appropriate fluid during trauma resuscitation.
What did we learn from the recent years?
• Allogenic blood should be avoided as far as possible; it cannot, however, be completely eliminated from our strategy to manage the hemorrhagic shock patient.
• Human albumin is the most expensive plasma substitute.,and has been shown to be a safe plasma substitute; however, no beneficial effects on perfusion, inflammation, tissue Edema or, organ function and no beneficial effects on morbidity, mortality or the length of stay in ICU have been demonstrated in humans.
• Although there is convincing evidence that blood volume is restored more rapidly with colloids than with crystalloids and colloids are also more efficient to improve microcirculation, crystalloids are still often recommended as the first choice to treat hemorrhage.
• Using high doses of crystalloids is associated with the risk of fluid overload, and using saline solution is associated with the risk of hyperchloremic acidosis.
• Crystalloids are often recommended for treating hypovolemia because they are cheap and are suggested to have only few side effects. Delayed and inadequate restoration of intravascular circulating volume by crystalloids, however, have been shown to worsen microvascular flow, endothelial integrity, and tissue oxygenation.
• Great enthusiasm has been expressed for hypertonic saline or hypertonic/colloid solutions in the treatment of hypovolemic shock in the trauma patient. Hypertonic solutions and hypertonic/colloid solutions may improve hemodynamics on multiple levels.
• The determination of which end points should be chosen when volume is administered remains unsolved. Although often used, clinical signs (e.g. pulse,blood pressure,and urine output) of hypovolemia are nonspecific and insensitive.
• Cardiac filling pressures, including the central venous pressure pulmonary artery occlusion pressure, have been traditionally used to guide fluid management. However, studies performed during the past 30 years have demonstrated that cardiac filling pressures are unable to predict fluid responsiveness.
• During the past decade, a number of dynamic tests of volume responsiveness have been reported. These tests dynamically monitor the change in stroke volume after a maneuver that increases or decreases venous return (preload) and challenges the patients’ Frank-Starling curve.
• Unfortunately, the debate on the choice of the fluid- replacement strategy in the trauma patient is widely influenced by personal choices, availability, cost, and emotions.