Permissive hypotensive resuscitation--an evolving concept in trauma.

Trauma fluid resuscitation continues to be a hotly debated issue. There is overwhelming experimental evidence to suggest that administration of resuscitation fluids is not entirely innocuous. Aggressive intravenous crystalloid administration in the presence of uncontrolled hemorrhage promotes continued bleeding and increases mortality. However this is countered by concerns that avoidance of fluids in the resuscitative phase may lead to tissue hypoperfusion, organ failure and death prior to control of bleeding. It may also have a deleterious effect on neurologic outcome in patients with TBI as well as increase the number of unnecessary operations. Currently there is no clear cut universal consensus pertaining to the optimal resuscitation strategy in trauma patients. However most prudent trauma surgeons propose, that a policy of judicious fluid administration to maintain the MAP in the 60-80 mmHg range is advisable and appropriate. Fluid resuscitation in trauma should be considered a double edged sword (too much too early or too little too late!). It should not be considered definitive therapy; as in a number of trauma patients it is only a temporizing measure, until surgical control of bleeding can be achieved.