Crystalloid-based fluid resuscitation has long been a cornerstone in the initial management of trauma-induced hemorrhagic shock. However, its benefit is increasingly questioned as it is suspected to increase bleeding and worsen coagulopathy. The emergence of alternative strategies like permissive hypotension and vasopressor use lead to a shift in early trauma care practices. Critical appraisal of current evidence is necessary to guide clinicians and outline research perspectives. Current guidelines for managing trauma-induced hemorrhagic shock suggest titrating fluids and using vasopressors to achieve minimal blood pressure targets until hemorrhage is controlled. In case of traumatic brain injury with severe hemorrhage, blood pressure target increases. The scientific literature supporting these recommendations is limited, and several aspects remain the subject of ongoing scientific debate. The aim of this review is to evaluate the existing evidence on low-volume fluid resuscitation during the first hours of trauma management, with an emphasis on its integration with permissive hypotension, vasopressor use and cerebral perfusion pressure in traumatic brain injury. The review also highlights the limitations of current guidelines, particularly the lack of robust evidence supporting specific type of fluid, volumes and administration protocols tailored to specific trauma scenarios and populations. Emerging technologies such as point-of-care diagnostics, integrated monitoring systems, and machine learning hold promise for enhancing clinical decision-making in trauma care. These innovations could play a crucial role, ultimately helping clinicians address critical unanswered questions in trauma management and improve patient survival. Crystalloid-based resuscitation remains relevant in early trauma care, but its application must be reassessed considering recent evidence and evolving practices. Further research is essential to refine fluid resuscitation guidelines, particularly in defining safe fluid volumes and the role of vasopressors. The integration of advanced monitoring technologies may offer new opportunities to optimize trauma care and improve outcomes.

中文翻译：

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在创伤引起的失血性休克的最初几个小时内，基于晶体液的液体膨胀策略是否仍然相关？


长期以来，基于晶体液的液体复苏一直是创伤性出血性休克初始治疗的基石。然而，它的益处越来越受到质疑，因为它被怀疑会增加出血并加重凝血病。允许性低血压和血管加压药使用等替代策略的出现导致早期创伤护理实践的转变。对当前证据的批判性评估对于指导临床医生和概述研究观点是必要的。目前管理创伤性失血性休克的指南建议滴定液体并使用血管加压药以达到最低血压目标，直到出血得到控制。在创伤性脑损伤伴有严重出血的情况下，血压目标会增加。支持这些建议的科学文献有限，有几个方面仍然是正在进行的科学辩论的主题。本综述的目的是评估在创伤管理的最初几个小时内低容量液体复苏的现有证据，重点是它与创伤性脑损伤中的允许性低血压、血管加压药使用和脑灌注压的整合。本综述还强调了当前指南的局限性，特别是缺乏强有力的证据来支持针对特定创伤情景和人群量身定制的特定类型的液体、容量和给药方案。即时诊断、集成监测系统和机器学习等新兴技术有望增强创伤护理的临床决策。这些创新可以发挥关键作用，最终帮助临床医生解决创伤管理中的关键未解之谜并提高患者生存率。 基于晶体液的复苏在早期创伤护理中仍然相关，但必须考虑到最近的证据和不断发展的实践，重新评估其应用。进一步的研究对于完善液体复苏指南至关重要，尤其是在定义安全液体量和血管加压药的作用方面。先进监测技术的整合可能会为优化创伤护理和改善结果提供新的机会。