Volume replacement after trauma: an update

Traditionally, fluid therapy in trauma patients favoured liberal replacement of intravascular fluids to correct fluid loss and optimise macro- and microcirculation. This narrative review examines the background for the changed approach to volume therapy, discusses important clinical studies and points out open questions for future research. Evidence is emerging that low volume resuscitation and permissive hypotension may be associated with improved outcomes. Crystalloids are safe as first line fluids. Colloids have no advantage over crystalloids and may be detrimental in patients with traumatic brain injury. Synthetic colloids may prolong bleeding and increase need for blood products. The role of hypertonic saline is unclear, as recent large-scale trials have been stopped for futility and some safety concerns.