Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries

Bickell, WH; Wall, Matthew B.; Pepe, PE; Martin, R. C.; Ginger, VF; Allen, MK; Kl, Mattox

doi:10.1016/0300-9572(95)90705-m

Cited by 53 publications

(62 citation statements)

References 17 publications

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“…fluids. 34,42 More recent clinical research has supported this concept. A large, prospective, controlled clinical trial comparing immediate prehospital and emergency department (ED) i.v.…”

Section: Intravenous Fluid Resuscitationmentioning

confidence: 96%

“…In addition, in the prospective clinical trial of fluid resuscitation from Houston, patients who had SBP of less than 70 mmHg were generally pulseless and clinically moribund. 42 Their chances of survival were very low regardless of their prehospital treatment. At the same time, retrospective subanalysis of all patients with injury severity scores of greater than 26 showed worse outcomes with early fluid resuscitation.…”

Section: Role Of Fluid Resuscitation In the Moribund Patientmentioning

confidence: 99%

“…At the same time, retrospective subanalysis of all patients with injury severity scores of greater than 26 showed worse outcomes with early fluid resuscitation. 42 Therefore, despite the animal data, statistically significant evidence from prospective clinical trials is still lacking regarding the value of fluid resuscitation for this small cohort of the most severely injured patients. This…”

Section: Role Of Fluid Resuscitation In the Moribund Patientmentioning

confidence: 99%

“…fluid resuscitation with fluid resuscitation delayed until arrival in the operating room was conducted in Houston, Texas. 42 In this study, hypotensive patients with penetrating torso injuries received either aggressive isotonic fluid resuscitation preoperatively (immediate group) or were given fluids only on arrival in the operating room (delayed group). Patients in the immediate resuscitation group had higher mortality rates, along with higher rates of postoperative complications, compared with patients in the delayed resuscitation group.…”

Section: Intravenous Fluid Resuscitationmentioning

confidence: 99%

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Controversies in the prehospital management of major trauma

Pepe

2000

Emergency Medicine

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Many traditional therapies in the prehospital management of major trauma may be of little value or may be even harmful. Little scientific evidence exists to support the use of the pneumatic antishock garment, and some studies have shown it to worsen outcome. The traditional role of intravenous fluid resuscitation also has been questioned and, in situations such as penetrating truncal trauma, it may be associated with comparatively worse outcomes. Although some infusion may be appropriate in severe haemorrhage, the clear priority in such patients is evacuation to definitive surgical intervention. Airway control and establishment of intravenous access are recommended en route. Endotracheal intubation may be capable of prolonging the ability to tolerate circulatory arrest, but overzealous ventilation may further compromise cardiac output where there is severe haemodynamic instability. If these procedures delay patient transport, any benefit they may offer could be outweighed by delaying definitive care. Many of the paradigms of prehospital trauma care should be reconsidered and carefully evaluated in future randomized controlled trials.

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“…fluids. 34,42 More recent clinical research has supported this concept. A large, prospective, controlled clinical trial comparing immediate prehospital and emergency department (ED) i.v.…”

Section: Intravenous Fluid Resuscitationmentioning

confidence: 96%

Section: Role Of Fluid Resuscitation In the Moribund Patientmentioning

confidence: 99%

Section: Role Of Fluid Resuscitation In the Moribund Patientmentioning

confidence: 99%

Section: Intravenous Fluid Resuscitationmentioning

confidence: 99%

See 2 more Smart Citations

Controversies in the prehospital management of major trauma

Pepe

2000

Emergency Medicine

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“…Hypotensive resuscitation has been shown to reduce blood product requirements, reduce coagulopathy and improve outcomes in trauma patients with major haemorrhage. 27,28 Recommendations vary, however typically, a systolic blood pressure of 80-90 mmHg should be targeted during initial resuscitation or 60 mmHg in the context of penetrating chest trauma.…”

Section: Hypotensive Resuscitationmentioning

confidence: 99%

Integrated major haemorrhage management in the retrieval setting: Damage control resuscitation from referral to receiving facility

Wijesuriya

Keogh

2017

Emerg Medicine Australasia

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Major haemorrhage is a leading cause of death in critically ill or injured patients requiring medical retrieval and presents significant clinical and logistic challenges irrespective of patient location, primary pathophysiology or mode of transport. It is essential that all care providers involved in the retrieval patient pathway, including referring hospitals, ambulance services, retrieval teams and tertiary receiving centres, adopt a common approach to the management of this complex patient group through the use of retrieval-specific, integrated protocols. These should incorporate the latest clinical evidence base, recognise the differences between primary and inter-facility missions and clearly define the roles and responsibilities of the retrieval clinical coordinator. By unifying the response across services, the aim is to facilitate seamless transition of care with ongoing damage control resuscitation from point of referral, during transfer and on arrival at the receiving centre.

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Translational barriers and opportunities for emergency preservation and resuscitation in severe injuries

Alam

2011

British Journal of Surgery

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Background: Hypothermia is commonly used for organ and tissue preservation in multiple clinical settings, but its role in the management of injured patients remains controversial. There is no doubt that temperature modulation is a powerful tool, and hypothermia has been shown to protect cells during ischaemia and reperfusion, decrease organ damage and improve survival. Yet hypothermia is a double-edged sword: unless carefully managed, its induction can be associated with a number of complications.Methods: A literature review was performed to include important papers that address the impact of hypothermia on key biological processes, and explore the potential therapeutic role of hypothermia in trauma/haemorrhage models.

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Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries

Abstract: Background Fluid resuscitation may be detrimental when given before bleeding

Cited by 53 publications

References 17 publications

Controversies in the prehospital management of major trauma

Controversies in the prehospital management of major trauma

Integrated major haemorrhage management in the retrieval setting: Damage control resuscitation from referral to receiving facility

Translational barriers and opportunities for emergency preservation and resuscitation in severe injuries

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