Intraoperative hypotensive resuscitation for patients undergoing laparotomy or thoracotomy for trauma

Abstract

Therapeutic study, level II.

Hypotensive Resuscitation among Trauma Patients

“…Since the early 1990s, a handful of randomized controlled trials have been conducted in trauma patients either in the prehospital or in-hospital and intraoperative setting [7–11]. …”

“…While the mean MAP for each patient was not statistically different between groups, when analyzing each intraoperative mean arterial pressure recorded approximately every 20 seconds, the amount of time spent below the target MAP was significantly less for the LMAP group compared to the HMAP group (12.6% versus 35.2%, p < 0.001). This suggests that it is not as difficult for a patient to independently maintain an intraoperative MAP above 50 mmHg as it is to maintain one above 65 mmHg [11]. …”

“…Three of the studies were conducted in the prehospital setting [7, 8, 10] and two were conducted upon arrival to the hospital [9] or intraoperatively [11]. Two studies were conducted within only penetrating trauma populations [7, 11], whereas three examined blunt or penetrating traumas [8–10]. Three studies excluded patients with a known or suspected head injury [9–11].…”

“…Two studies were conducted within only penetrating trauma populations [7, 11], whereas three examined blunt or penetrating traumas [8–10]. Three studies excluded patients with a known or suspected head injury [9–11]. The studies by Turner et al and Schreiber et al specifically excluded burn patients [8, 10].…”

“…The goal is to limit additional bleeding due to “popping the clot” while still providing oxygen to the tissues [4, 5]. 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 [7–11]. …”