Abstract
BackgroundModern resuscitation strategies following haemorrhagic shock are influenced by global haemodynamic parameters such as blood pressure and cardiac output. Microcirculatory dysfunction in this context may persist even after restoration of satisfactory global parameters. Additional monitoring of the microcirculatory function may therefore be warranted in order to facilitate goal-directed therapy at a tissue oxygenation level. Although such a phenomenon is recognised in the case of sepsis, clinical evidence regarding the behaviour of the microcirculation following the delivery of resuscitation fluids after haemorrhagic shock is sparse. A summation of the current state of pre-clinical evidence is justified in order to direct avenues for future clinical research.Methods/designSystematic review methodology will be utilised in order to identify relevant studies, assess for bias, and extract data for analysis. Medical databases will be searched to find pre-clinical studies that monitor the microcirculatory function following haemorrhagic shock and subsequent fluid resuscitation. Different fluid types (e.g. blood products, crystalloid, and colloid fluids) will be compared. The search strategy will combine terms for the animal model, resuscitation fluid, and microcirculatory parameters. Randomised and non-randomised experiments, as well as case series, will be eligible for inclusion. Specific quality assessment tools for pre-clinical research will be used depending on study design. A combination of narrative and meta-analysis techniques will be used for the synthesis of data.DiscussionThe choice of type, sequence, and quantity of resuscitation fluid following haemorrhagic shock is controversial, and the optimal strategy for restoration of microcirculatory function is yet unknown. A detailed examination of pre-clinical data regarding the microcirculation is timely and will enable a focussed approach to clinical research for the improvement of resuscitation following haemorrhagic shock.Systematic review registrationCollaborative Approach to Meta Analysis and Review of Animal Data from Experimental Studies (CAMARADES)Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0113-4) contains supplementary material, which is available to authorized users.
Highlights
Modern resuscitation strategies following haemorrhagic shock are influenced by global haemodynamic parameters such as blood pressure and cardiac output
Inclusion and exclusion criteria Type of study Any pre-clinical study may be eligible for inclusion if it reports data regarding the impact of resuscitation fluids on the microcirculation in an animal model that has been subject to any form of haemorrhagic shock
These may include randomised controlled trials or prospective case series or controlled studies
Summary
The optimal volume, ratios, type, sequence of delivery, and timing of resuscitation fluids following haemorrhagic shock of trauma remain controversial. In order to plan and conduct clinical investigation of the microcirculation following haemorrhagic shock and fluid resuscitation, it is first advisable to examine all the available pre-clinical evidence. This may enable greater focus and attention towards certain avenues and research questions of interest. This systematic review will examine the pre-clinical evidence available with regard to microcirculatory function following resuscitation in the context of haemorrhagic shock and will propose clinical questions of interest based on the findings. Additional file 1: Sample search strategy in MEDLINE. All authors read, provided feedback, and approved the final manuscript
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