Palavras-chave
Volume resuscitation
Hemostatic resuscitation
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Resumo
Objetivo: Analisar os avanços nas estratégias de reposição volêmica no trauma hemorrágico, enfatizando as evidências atuais relacionadas à ressuscitação hemostática e seu impacto nos desfechos clínicos. Revisão bibliográfica: A hemorragia constitui a principal causa de morte evitável no trauma, tornando o manejo precoce do choque hemorrágico fundamental para a sobrevida. Nas últimas décadas, observou-se uma mudança de paradigma, com substituição da reposição liberal de cristaloides por estratégias de ressuscitação de controle de danos, que incluem hipotensão permissiva, hemoterapia balanceada, uso precoce do ácido tranexâmico e monitorização individualizada da coagulação. Evidências demonstram que essas abordagens reduzem complicações como hemodiluição, acidose, coagulopatia e sobrecarga volêmica, além de favorecerem o controle da hemorragia e a preservação da perfusão tecidual. Considerações finais: Os avanços na reposição volêmica transformaram o tratamento do trauma hemorrágico, priorizando estratégias baseadas em evidências que otimizam a hemostasia e reduzem a mortalidade. A adoção de protocolos atualizados e individualizados representa um componente essencial para melhorar os desfechos clínicos de pacientes vítimas de trauma.
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