Abstract
Hemorrhagic shock is a principal cause of death among trauma patients within the first 24 hours after injury. Optimal fluid resuscitation strategies have been examined for nearly a century, more recently with several randomized controlled trials. Hypotensive resuscitation, also called permissive hypotension, is a resuscitation strategy that uses limited fluids and blood products during the early stages of treatment for hemorrhagic shock. A lower-than-normal blood pressure is maintained until operative control of the bleeding can occur. The randomized controlled trials examining restricted fluid resuscitation have demonstrated that aggressive fluid resuscitation in the prehospital and hospital setting leads to more complications than hypotensive resuscitation, with disparate findings on the survival benefit. Since the populations studied in each randomized controlled trial are slightly different, as is the timing of intervention and targeted vitals, there is still a need for a large, multicenter trial that can examine the benefit of hypotensive resuscitation in both blunt and penetrating trauma patients.
Highlights
In the United States, trauma is the leading cause of death for persons between the ages of 1 and 44 years and the fifth leading cause of death overall [1]
Hemorrhagic shock is a principal cause of death among trauma patients accounting for approximately 30–40% of deaths within the first 24 hours after injury [3]
Over the past 30 years, there has been a renewed interest in research focusing on the optimal resuscitation strategies for trauma patients, those with uncontrolled hemorrhage, in hopes of decreasing mortality from hemorrhagic shock
Summary
In the United States, trauma is the leading cause of death for persons between the ages of 1 and 44 years and the fifth leading cause of death overall [1]. Hemorrhagic shock is a principal cause of death among trauma patients accounting for approximately 30–40% of deaths within the first 24 hours after injury [3]. Over the past 30 years, there has been a renewed interest in research focusing on the optimal resuscitation strategies for trauma patients, those with uncontrolled hemorrhage, in hopes of decreasing mortality from hemorrhagic shock. This review focuses on hypotensive resuscitation, called permissive hypotension. This resuscitation strategy uses limited fluids and blood products during the early stages of treatment for hemorrhagic shock in order to maintain a lower-than-normal blood pressure until operative control of the bleeding can occur. The use of restricted fluids has been shown to improve outcomes in animal models [6]; until recently, few randomized controlled trials on hypotensive resuscitation existed in trauma patients [7,8,9,10,11]
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