Delirium in Trauma Patients: Prevalence and Predictors.

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Abstract

[Indexed for MEDLINE] 13. Eur J Trauma Emerg Surg. 2017 Aug;43(4):439-443. doi: 10.1007/s00068-017-0771-0. Epub 2017 Feb 27. Volume replacement during trauma resuscitation: a brief synopsis of current guidelines and recommendations. Maegele M(1)(2), Fröhlich M(3), Caspers M(3)(4), Kaske S(3). Author information: (1)Department for Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke (UW/H), Ostmerheimerstr. 200, 51109, Cologne, Germany. Marc.Maegele@t-online.de. (2)Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke (UW/H), Campus Cologne-Merheim, Ostmerheimerstr. 200, 51109, Cologne, Germany. Marc.Maegele@t-online.de. (3)Department for Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke (UW/H), Ostmerheimerstr. 200, 51109, Cologne, Germany. (4)Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke (UW/H), Campus Cologne-Merheim, Ostmerheimerstr. 200, 51109, Cologne, Germany. INTRODUCTION: Intravascular volume and fluid replacement are still cornerstones to correct fluid deficits during early trauma resuscitation, but optimum strategies remain under debate. METHODS: A synopsis of best current knowledge with reference to the following guidelines and recommendations is presented: (1) The European Guideline on Management of Major Bleeding and Coagulopathy following Trauma (fourth edition), (2) S3 Guideline on Treatment of Patients with Severe and Multiple Injuries [English Version of the German Guideline S3 Leitlinie Polytrauma/Schwerverletzten-Behandlung/AWMF Register-Nr. 012/019 sponsored by the German Society for Trauma Surgery/Deutsche Gesellschaft für Unfallchirurgie (DGU)], and (3) S3 Guideline Intravascular Volume Treatment in the Adult [AWMF Register-Nr 001/020 sponsored by the German Society for Anesthesiology and Intensive Medicine/Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)]. RESULTS AND CONCLUSIONS: Volume replacement at a reduced level in severely injured and bleeding trauma patients is advocated (permissive hypotension) until the bleeding is controlled. ATLS principles with Hb, BE, and/or lactate can assess perfusion, estimate/monitor the extent of bleeding/shock, and guide therapy. Isotonic crystalloid solutions are first-line and specific recommendations apply for patients with TBI. DOI: 10.1007/s00068-017-0771-0