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Letters Early fluid resuscitation in severe trauma

Authors’ reply to Wiles and Chitnavis

BMJ 2012; 345 doi: (Published 30 October 2012) Cite this as: BMJ 2012;345:e7266
  1. Tim Harris, professor of emergency medicine 12,
  2. G O Rhys Thomas, lieutenant colonel and honorary consultant 342,
  3. Karim Brohi, professor of trauma sciences and consultant trauma and vascular surgeon 12
  1. 1Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  2. 2Barts Health NHS Trust, London
  3. 316 Air Assault Medical Regiment
  4. 4Royal London and Queen Victoria, East Grinstead, UK
  1. tim.harris{at}

Wiles discussed the lack of high quality evidence on damage control resuscitation, permissive hypotension in particular.1 2 We agree that large robust randomised controlled trials are lacking. However, in all clinical trials of fluid replacement during the acute bleeding phase in trauma patients, outcomes have been better or equivalent with lower volume resuscitation.

Wiles also discussed the role of permissive hypotension in traumatic brain injury and …

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