Outcome of raising blood pressure in patients with penetrating trunk wounds

Abstract

In many countries, the management of patients with traumatic wounds follows the guidelines from the American College of Surgeons Advanced Trauma Life Support Program for Physicians (ATLS) 1 American College of Surgeons. Shock. In: American College of Surgeons, ed. American College of Surgeons, Committee on Trauma. Advanced trauma life support program for physicians: instructor manual, 1997. Google Scholar but the protocol relating to penetrating wounds has recently come under scrutiny. Investigators have suggested that under ideal conditions delaying fluid resuscitation until operative intervention may improve survival. 2 Bickell WH Wall Jr, MJ Pepe PE et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries.. N Engl J Med. 1994; 331: 1105-1109 Crossref PubMed Scopus (1692) Google Scholar Raising the blood pressure in these patients may lead to increased haemorrhage caused by dislodgement of thrombus. 3 Shafton GW Clive CJ Dennis C Harris B Fundamentals of physiologic control of arterial hemorrhage.. Surgery. 1965; 58: 851-856 PubMed Google Scholar Intravenous fluids may also dilute coagulation factors 4 Bickell WH Bruttig SP Millnamow GA OBenar J Wake CE The detrimental effects of intravenous crystalloid after aortotomy in swine.. Surgery. 1991; 110: 529-536 PubMed Google Scholar and lower blood viscosity, decreasing resistance to flow around an incomplete thrombus. 5 Bickell WH Bruttig SP Millnamow GA OBenar J Wake CE Use of hypertonic saline/dextran versus lactated Ringer's solution as a resuscitation fluid after uncontrolled aortic hemorrhage in anesthetized swine.. Ann Emerg Med. 1992; 21: 1077-1085 Summary Full Text PDF PubMed Scopus (149) Google Scholar We tested the hypothesis that raising blood pressure between admission and operation in patients with penetrating wounds to the trunk had a deleterious effect on outcome, under a more realistic worst-case scenario.