Management of trauma patients with hemorrhagic shock
is complex and difficult. We recommend managing these
patients in centers that treat a high volume of patients (i.e.,
trauma centers). During recent decades, despite our increasing
knowledge of the pathophysiology of hemorrhagic
shock in trauma patients, the mortality rate continues to
remain high. The role of the physician is to maintain oxygen
delivery, despite ongoing bleeding, and to limit tissue
hypoxia, inflammation, and organ dysfunction. At the same
time, the physician must maintain surgical and arteriographic
control of the bleeding and treat coagulopathy to
stop hemorrhage in these patients. The optimal resuscitative
strategy remains controversial. To move forward, we
need to establish optimal therapeutic approaches with clear
objectives for fluid resuscitation, blood pressure, and
hemoglobin levels to guide resuscitation and limit the risk
of fluid overload resuscitation and transfusion.