Recommandations formalisées d`experts Recommandations sur la

Recommandations,formalisées,d’experts,
,
Recommandations,sur,la,réanimation,du,choc,hémorragique,
Guidelines)on)the)treatment)of)hemorrhagic)shock)
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='!B#+C&'!A*#+E#0('!G6I?JH.!='!B#!64$07,7!A*#+E#0('!='!17='$0+'!=F&*C'+$'!G6J>KH!',!=&!L*4&D'!=F7,&='(!(&*!
BF3714(,#('!',!B#!,3*4154('!GLMNOH!!
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8#*0(.!K+0:'*(0,7!8#*0(!6&=!RS.TU.!*&'!=&!L7+7*#B!?'$B'*$.!VWXTY!?'!/*'1B0+@Z0$[,*'.!J*#+$'!
5 6'*:0$'!=\#+'(,37(0'.!*7#+01#,04+!$30*&*C0$#B'.!NP,'B!)0'&.!]NK!^#+,'(.!WW_`Y!^#+,'(!$'='Q!a.!J*#+$'!
$K+0,7! =F2+'(,37(04B4C0'.! S+(,0,&,! K+0:'*(0,#0*'! =&! ]#+$'*! O4&B4&('! b! ;+$4D4B'.! 1 avenue Irène Joliot-Curie
31059 Toulouse Cedex 9, France
= Service d’Anesthésie-Réanimation, CHRU, Université de Bretagne Occidentale, Hôpital de la Cavale Blanche,
1, boulevard Tanguy Prigent, 29609 Brest, France!
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20Q@>#*('0BB'!K+0:.!a`VaY!>#*('0BB'!$'='Q!X_.!J*#+$'!
A!6'*:0$'(!='(!*7#+01#,04+(.!=0:0(04+!#+'(,37(0'!*7#+01#,04+!=4&B'&*!&*C'+$'.!]NK!^c1'(.!8B#$'!=&!8*!I45'*,!
)'5*7.!`__XV!^c1'(!$'='Q!V.!J*#+$'!
)
Comité,d’organisation,
8*7(0='+,(!d!"#!$%&'()*(&+!,#!-*./(0&/*!
80B4,'(!=F'QD'*,(!d!,#1#!2&3./(0+!4#!2&)(&+!1#!567&.!!
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Experts)))
64$07,7!='!*'#+01#,04+!='!B#+C&'!A*#+E#0('!G6I?JH!d!8#!$%3/.+!,#2!9&:)*;!
64$07,7!A*#+E#0('!='!17='$0+'!=F&*C'+$'!G6J>KH!d!<#!$=(&0+!"#!9/6/.)*.0&!
L*4&D'!=F7,&='(!(&*!BF3714(,#('!',!B#!,3*4154('!GLMNOH!d!>#!>*%&(!
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64$07,7!A*#+E#0('!=F#+'(,37(0'!',!='!*7#+01#,04+!G6A#*H!d!?#!@)(%0/(0+!A#!B.*=&.+!>#!-/'C/(7+!
,#>#! -/D7=+! $#! E)=7&.+! -#! E/..7F*&%+! 9#! E&&./&.0%+! >#! G/C/=/+! -! ,)*.()7%+! 5#!2/(F&.)(+! E#!
2&:*33&+!4#!2&F./(=+!8#4#!4&.0&%+!E#!5.;7/F*&0+!@#!8/*F/C+!,#<#!8/H&(+!I#!87.7)*+!>!87&..&+!B#!
J7)*+!!A!J)%&(K'&.+!+!B#!I7F*L#!
!
Chargés,de,bibliographie,
Oe!L#&((.!2e!N#**40(.!>e!I#&Q.!2e!I4%&0BBf!
,
*Auteur,correspondant,:,!"#$%&'(!)&*#+,'#&!Gg#$%&'(e=&*#+,'#&h5$,e#D3DeA*H,

!
1. Résumé,,
2M):N&K073!=&!K&00&!J<O!&%0!=ML=70&.!=&%!.&K)CC/(=/07)(%!%*.!;/!P.7%&!&(!K'/.F&!=*!K')K!'LC)../F7Q*&+!R!;/!
P'/%&! P.LK)K&+! &(! P.L! &0! &(! 7(0./')%P70/;7&.#! -&! P/.!;&*.%!P/.07K*;/.70L%+! ;M'LC)../F7&! =7F&%07D&! &0!
;M'LC)../F7&!):%0L0.7K/;&!)(0!L0L!&SK;*&%!=*!K'/CP!=&!K&00&!J<O#!
2).%!=&!;/!P'/%&!7(707/;&!=M*(!K')K!'LC)../F7Q*&+!0/(0!Q*&!;&!%/7F(&C&(0!(M&%0!P/%!K)(0.T;L+!7;!&%0!&%%&(07&;!
=MLD70&.!*(&!/FF./D/07)(!=*!%/7F(&C&(0!P/.!*(&!=7;*07)(!=&%!3/K0&*.%!=&!;/!K)/F*;/07)(!&0!=&%!):N&K073%!=&!
P.&%%7)(!/.0L.7&;;&!&SK&%%73%+!&0!*(!.&0/.=!=&!0./70&C&(0!=M*(&!LD&(0*&;;&!K)/F*;)P/0'7&#!!
?;! 3/*0! P.):/:;&C&(0! 0);L.&.! *(! K&.0/7(! =&F.L! =M'HP)0&(%7)(! /.0L.7&;;&! UP.&%%7)(! /.0L.7&;;&! %H%0);7Q*&!
U8$>V! W!XYZ[Y! CCGF+! &(! ;M/:%&(K&! =&! 0./*C/07%C&! K.\(7&(! F./D&V! &0! ! ;7C70&.! ;&! .&CP;7%%/F&! /*! %0.7K0!
C/7(07&(!=&!K&%!):N&K073%!=&!P.&%%7)(!/.0L.7&;;&!P)*.!C7(7C7%&.!;&%!.7%Q*&%!=M/FF./D/07)(!=*!%/7F(&C&(0!
0/(0!Q*&!;M'LC)%0/%&!K'7.*.F7K/;&!&0])*!./=7)Z7(0&.D&(07)((&;;&!(M&%0!P/%!.L/;7%L&#!!
?;! &%0! .&K)CC/(=L! =M*07;7%&.! &(! P.&C7^.&! 7(0&(07)(! ;&%! %);*0L%! K.7%0/;;)_=&%! ;).%! =&! ;/! P.7%&! &(! K'/.F&!
7(707/;&! =*! P/07&(0! &(! K')K! 'LC)../F7Q*&#! 2M*07;7%/07)(! =&%! %PLK7/;70L%! R! :/%&! =M'H=.)SHL0'H;/C7=)(%!
UGO$V! (&! =)70! %M&(D7%/F&.! Q*&! ;).%Q*&! ;M*07;7%/07)(! =&%! K.7%0/;;)_=&%! %&*;%! &%0! N*FL&! 7(%*337%/(0&! P)*.!
C/7(0&(7.!;/!D);LC7&!&0!&(!;M/:%&(K&!=&!;&*.%!K)(0.&Z7(=7K/07)(%#!!
$P.^%!/D)7.!=L:*0L!*(!.&CP;7%%/F&!D/%K*;/7.&+!!7;!3/*0!P.):/:;&C&(0!/=C7(7%0.&.!*(!D/%)P.&%%&*.!&(!K/%!
=&! P&.%7%0/(K&! =`*(&! 'HP)0&(%7)(! /.0L.7&;;&! U8$>! aXY! CCGFV#! ?;! 3/*0! P.):/:;&C&(0! /=C7(7%0.&.! ;/!
()./=.L(/;7(&!&(!P.&C7^.&!7(0&(07)(#!-/(%!*(!K)(0&S0&!=`*.F&(K&+!&0!=/(%!;`/00&(0&!=&!;/!P)%&!=`*(!/KK^%!
K&(0./;+!K&00&!/=C7(7%0./07)(!P)*../!%&!3/7.&!%*.!*(&!D)7&!PL.7P'L.7Q*&#!
?;!&%0!.&K)CC/(=L!Q*M*(&!P.)KL=*.&!;)K/;&!=&!F&%07)(!=&!;`'LC)../F7&!C/%%7D&!%)70!L;/:).L&!=/(%!K'/Q*&!
%0.*K0*.&!CL=7K)ZK'7.*.F7K/;&!/D&K!*(&!/PP.)K'&!C*;07=7%K7P;7(/7.&#!!
?;!&%0!.&K)CC/(=L!=`/=C7(7%0.&.!=&!;`/K7=&!0./(&S/C7Q*&!=^%!Q*&!P)%%7:;&!=/(%!;&%!0.)7%!P.&C7^.&%!'&*.&%!
=&! ;/! %*.D&(*&! =M*(! K')K! 'LC)../F7Q*&#! 2/! 0./(%3*%7)(! =&! P;/%C/! =)70! b0.&! =L:*0L&! ./P7=&C&(0+!
7=L/;&C&(0! &(! CbC&! 0&CP%! Q*&! K&;;&! =&%!K)(K&(0.L%! =&! F;):*;&%! .)*F&%! U@EJV#! ?;! 3/*0! P.):/:;&C&(0!
0./(%3*%&.!;&!P;/%C/!3./7%!K)(F&;L!&(!/%%)K7/07)(!/D&K!;&%!@EJ!/D&K!*(!./07)!8<@c@EJ!K)CP.7%!&(0.&!dce!&0!
dcd#!?;!&%0!.&K)CC/(=L!=&!C&00.&!&(!f*D.&!*(&!0./(%3*%7)(!P;/Q*&00/7.&!P.LK)K&+!FL(L./;&C&(0!;).%!=&!;/!
=&*S7^C&! P.&%K.7P07)(! 0./(%3*%7)((&;;&+! P)*.! C/7(0&(7.! ;/! (*CL./07)(! =&%! P;/Q*&00&%! /*Z=&%%*%! =&! gY!
E]2!UdYY!E]2!&(!K/%!=&!0./*C/07%C&!K.\(7&(!/%%)K7LV#!?;!3/*0!P.):/:;&C&(0!0./(%3*%&.!=&%!P;/Q*&00&%!K'&6!
;&%! P/07&(0%! P.L%&(0/(0! *(&! 'LC)../F7&!%LD^.&! &0])*! *(&! 'LC)../F7&! 7(0./! K.\(7&((&! 0./70L%! P/.! =&%!
/F&(0%!/(07P;/Q*&00/7.&%#!2M/=C7(7%0./07)(!=&!K)(K&(0.L%!=&!37:.7()F^(&!&%0!P.):/:;&C&(0!.&K)CC/(=L&!
&(!K/%!=&!37:.7()FL(LC7&!hd+gF]2+!)*!=&!P/./C^0.&%!0'.)C:)L;/%0)ZF./P'7Q*&%!UZCL0.7Q*&%V!=&!=L37K70!&(!
37:.7()F^(&! 3)(K07)((&;#! O(! K/%! =&! K')K! 'LC)../F7Q*&! %*.D&(/(0! K'&6! *(! P/07&(0! 0./70L! P/.! $I"+! 7;! &%0!
.&K)CC/(=L!=`/=C7(7%0.&.!%/(%!=L;/7!=&%!K)(K&(0.L%!=&!K)CP;&S&!P.)0'.)C:7(7Q*&!U@@8V#!O(!K/%!=&!K')K!
'LC)../F7Q*&! %*.D&(/(0! K'&6! *(! P/07&(0! 0./70L! P/.! /(07K)/F*;/(0%! )./*S! =7.&K0%! U$5-V+! 7;! 3/*0!
P.):/:;&C&(0!0&(0&.!*(&!(&*0./;7%/07)(!7CCL=7/0&!=&!;M&33&0!/(07K)/F*;/(0!=&!;M$5-!P/.+!%)70!=*!<O?B$!iYZ
gY!j]kF+!%)70!=&%!@@8!gY!j]kF+!LD&(0*&;;&C&(0!.&()*D&;L%!d!3)7%!R!X!'!=M7(0&.D/;;&#!

!
2. Résumé,de,vulgarisation,,
2M):N&K073!=&!K&00&!J<O!&%0!=ML=70&.!=&%!.&K)CC/(=/07)(%!%*.!;/!P.7%&!&(!K'/.F&!=*!K')K!'LC)../F7Q*&+!R!;/!
P'/%&!P.LK)K&+!&(!P.L!&0!&(!7(0./!')%P70/;7&.#!
2).%! =&! ;/! P'/%&! 7(707/;&! =M*(! K')K! 'LC)../F7Q*&+! 7;! &%0! &%%&(07&;! =&! C/7(0&(7.! *(&! 3)(K07)(!
K/.=7)D/%K*;/7.&!&0!*(&!K/P/K70L!R!K)/F*;&.!0)*0!&(!LD70/(0!!=M/FF./D&.!;&!%/7F(&C&(0!P/.!*(&!=7;*07)(!=&%!
3/K0&*.%!=&!;/!K)/F*;/07)(!%&K)(=/7.&!/*!.&CP;7%%/F&!D/%K*;/7.&!&0!P/.!=&%!):N&K073%!=&!P.&%%7)(!/.0L.7&;;&!
&SK&%%73%#! ?;! 3/*0! ;7C70&.! ;&! .&CP;7%%/F&! /*! %0.7K0! C/7(07&(!=&%! =M):N&K073%! =&! P.&%%7)(! /.0L.7&;;&! P)*.!
C7(7C7%&.!;&%!.7%Q*&%!=M/FF./D/07)(!=*!%/7F(&C&(0#!?;!&%0!.&K)CC/(=L!=M*07;7%&.!&(!P.&C7^.&!7(0&(07)(!;&%!
%);*0L%! K.7%0/;;)_=&%! ;).%! =&! ;/! P.7%&! &(! K'/.F&! 7(707/;&! =*! P/07&(0! &(! K')K! 'LC)../F7Q*&#! $P.^%! /D)7.!
=L:*0L!*(! .&CP;7%%/F&! D/%K*;/7.&+! ! 7;! 3/*0! P.):/:;&C&(0! /=C7(7%0.&.! *(! D/%)P.&%%&*.! &(! K/%! =&!
P&.%7%0/(K&! =`*(&! 'HP)0&(%7)(! /.0L.7&;;&! U8$>! aXY! CCGFV#! !?;! &%0! .&K)CC/(=L! =M/D)7.! *(&! %0./0LF7&!
%0/(=/.=7%L&!=&!0./(%3*%7)(!C/%%7D&!P)*.!K)..7F&.!/*!P;*%!D70&!;&%!0.)*:;&%!=&!;/!K)/F*;/07)(#!
3. Préambule,,
a. 8.L%&(0/07)(!=&!;/!P.):;LC/07Q*&!=&!;/!.&K)CC/(=/07)(,
i. @)((/7%%/(K&!%*.!;&!%*N&0!,
2/! F&%07)(! P.L')%P70/;7^.&!&0! ')%P70/;7^.&! =M*(! K')K! 'LC)../F7Q*&! (LK&%%70&! =M/PP;7Q*&.! =&%! %0./0LF7&%!
0'L./P&*07Q*&%! &0! ).F/(7%/07)((&;;&%! K;/7.&%! =/(%! ;&! :*0! =&! K)(0.T;&.! /*! P;*%! D70&! ;&! %/7F(&C&(0! &0! =&!
=7C7(*&.!;&%!.7%Q*&%!=&!=H%3)(K07)(%!=M).F/(&%#!!O;;&!(LK&%%70&!*(&!P.7%&!&(!K'/.F&!C*;07=7%K7P;7(/7.&!)l!
K'/Q*&!L0/P&!)*!)P07)(!0'L./P&*07Q*&!=)70!b0.&!.L3;LK'7&!&(!0&.C&!=&!:L(L37K&%].7%Q*&%!/D&K!;M):%&%%7)(!
=&! (&! P/%! .&0/.=&.! ;&! K)(0.T;&! =*! %/7F(&C&(0#! >7! ;/! ;700L./0*.&! P).0/(0! %*.! ;&! K')K! 'LC)../F7Q*&! &%0!
7CP).0/(0&! &(! ()C:.&+!7;! %M/D^.&! Q*M&;;&! .&%0&! 0.^%! 7(')C)F^(&! &(! Q*/;70L! /D&K! =&! ()C:.&*S! 0./D/*S!
%)*33./(0!=&!3/7:;&%%&%!CL0')=);)F7Q*&%!U()(!P.)%P&K07D&+!()(!./(=)C7%L&+!&33&K073%!%)*D&(0!3/7:;&%+!P/%!
)*! P&*! =&! CL0/! /(/;H%&V#! $7(%7! =&! ()C:.&*S! P)7(0%! .&%0&(0! =L:/00*%+! P/.! &S&CP;&!;/! .L/;7%/07)(! =*!
.&CP;7%%/F&!D/%K*;/7.&+!;/!P;/K&!=&%!/F&(0%!D/%)P.&%%&*.%!&0!;/!%0./0LF7&!0./(%3*%7)((&;;&#!@&P&(=/(0!K&%!
L;LC&(0%!%)(0!K.*K7/*S!P)*.!L0/:;7.!=&%!%0./0LF7&%!K;/7.&%!P)*.!;M&(%&C:;&!=&%!/K0&*.%!7CP;7Q*L%!=/(%!;/!
P.7%&! &(! K'/.F&! =*! K')K! 'LC)../F7Q*&#! 2/! .L/;7%/07)(! =&! K&%! .&K)CC/(=/07)(%! 3).C/;7%L&%! =M&SP&.0%!
%M7(%K.70! =/(%! K&00&! P&.%P&K07D&! /37(! =M/7=&.! ;&%! LQ*7P&%! R! )P07C7%&.! ;&*.! P.7%&! &(! K'/.F&! =*! K')K!
'LC)../F7Q*&#!
ii. J/07)((&;!=&!;/!J<O,
2/!C).0/;70L!=/(%!;&%!em!P.&C7^.&%!'&*.&%!=*!K')K!'LC)../F7Q*&!&%0!=*&!&%%&(07&;;&C&(0!R!;M7CP)%%7:7;70L!
=&!K)(0.T;&.!;&!%/7F(&C&(0#!2&%!P.7).70L%!%)(0!=)(K!=&!=L0&.C7(&.!;M).7F7(&!=*!%/7F(&C&(0!&0!=&!K)(0.T;&.!
K&!%/7F(&C&(0! /*!P;*%! D70&#! @&%!P.7).70L%! =)7D&(0! %0.*K0*.&.!;/! P.7%&! &(! K'/.F&!=&%! P.&C7^.&%!'&*.&%! =*!
K')K! 'LC)../F7Q*&+! Q*&! K&! %)70! /*! :;)K! )PL./0)7.&! )*! &(! 0./*C/0);)F7&#! O(! 0./*C/0);)F7&+! ;&! =L;/7!
=M/..7DL&!R! ;M'TP70/;!&%0! *(! 3/K0&*.!=&!C).0/;70L!UdV#!2M7CP).0/(K&!=MLD70&.! 0)*0&! P&.0&! =&!0&CP%! ;).%!=&%!
P.7%&%!&(!K'/.F&!P.L')%P70/;7^.&!&0!')%P70/;7^.&!&%0!/*!K&(0.&!=*!K)(K&P0!=&%!K&(0.&%!%PLK7/;7%L%!=&!P.7%&!
&(! K'/.F&! =&%! 0./*C/07%L%! F./D&%! Q*7! /! K;/7.&C&(0! C)(0.L! *(&! =7C7(*07)(! =&! ;/! C).0/;70L! Ue+! iV#! O(!

P/./;;^;&! =&! ;/! .&K'&.K'&! &0! =*! K)(0.T;&! =*! %/7F(&C&(0+! 2&! :*0! =&! ;/! P.7%&! &(! K'/.F&! &%0! =&! ;7C70&.!
;M'HP)P&.3*%7)(!07%%*;/7.&+!;/!K)/F*;)P/0'7&+!;M7(3;/CC/07)(!&0!;&%!=H%3)(K07)(%!=M).F/(&%#!
iii. 5:N&K073%!=&!;/!J<O!
2M):N&K073!=&!K&00&!J<O!&%0!=ML=70&.!=&%!.&K)CC/(=/07)(%!%*.!;/!P.7%&!&(!K'/.F&!=*!K')K!'LC)../F7Q*&+!R!;/!
P'/%&! P.LK)K&+! &(! P.LZ! &0! 7(0./')%P70/;7&.#! -&! P/.!;&*.%! P/.07K*;/.70L%+! ;M'LC)../F7&! =7F&%07D&! &0!
;M'LC)../F7&!):%0L0.7K/;&!)(0!L0L!&SK;*&%!=*!K'/CP!=&!K&00&!J<O#!
iv. J&K'&.K'&!:7:;7)F./P'7Q*&!&0!K.70^.&%!=&!%L;&K07)(!
2&%! L0*=&%! P*:;7L&%! =/(%! 8*:C&=! &0! @)K'./(&! =/0/:/%&! R! P/.07.! =&! ;M/((L&! eYYY+! )(0! L0L! .LP&.0).7L&%#!
A)*%!(M/D)(%!P/%!.&0&(*!%&*;&C&(0!;&%! &%%/7%!./(=)C7%L%!K)(0.T;L%! /37(! =&! (&! P/%! &SK;*.&!=&%! =)((L&%!
K;7(7Q*&%!P&.07(&(0&%!:7&(!Q*&!CL0')=);)F7Q*&C&(0!P;*%!K.707Q*/:;&%#!2&%!L0*=&%!C/N&*.&%!P*:;7L&%!/D/(0!
K&00&!=/0&!)(0!L0L!7(K;*%&%#!
v. 8)P*;/07)(!&0!K)CP/./7%)(%!
>&*;&!;/!P)P*;/07)(!/=*;0&!&%0!K)(K&.(L&!P/.!K&00&!J<O#!
vi. @.70^.&%!=&!N*F&C&(0!
?;! (M/! P/%! L0L! P)%%7:;&! =&! =L37(7.! R! P.7).7! ;&%! K.70^.&%! =&! N*F&C&(0! P&.07(&(0! =&D/(0! ;M'L0L.)FL(L70L! =&!
;M/(/;H%&!=&!;/!;700L./0*.&#!2/!C).0/;70L!/!(L/(C)7(%!L0L!.&0&(*&!;&!P;*%!%)*D&(0!P)%%7:;&#!
vii. $(/;H%&!CL=7K)ZLK)()C7Q*&!
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a. Recommandation,1,,,
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