The impact of early administration of vasopressor agents for the resuscitation of severe hemorrhagic shock following blunt trauma

Uchida, Kenichiro; Nishimura, Tetsuro; Hagawa, Naohiro; Kaga, Shinichiro; Noda, Tomohiro; Shinyama, Naoki; Yamamoto, Hiromasa; Mizobata, Yasumitsu

doi:10.1186/s12873-020-00322-1

Cited by 13 publications

(21 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Microcirculation impairments or the degree of systemic inflammation due to norepinephrine use could be consequences of prolonged ICU stay. Our data are in accordance with Uchida et al, who showed that the use of norepinephrine could increase the mortality rate/ICU stay (13).…”

Section: Discussionsupporting

confidence: 93%

Isolated liver trauma: A clinical perspective in a non‑emergency center for liver surgery

et al. 2021

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 93%

Isolated liver trauma: A clinical perspective in a non‑emergency center for liver surgery

et al. 2021

View full text Add to dashboard Cite

“…In total, 367 patients (70% male) with a median age of 46 (28-61) years who were admitted to ICU and survived 48 hours were included. Ninety-six percent of injuries were caused by a blunt mechanism and median ISS was 29 (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) with most severe injuries located in the brain (AIS head 3 (1-3)) and chest (AIS chest 3 (2-4)). Eighty-six patients (23%) underwent an urgent laparotomy (table 1).…”

Section: Results Demographicsmentioning

confidence: 99%

“…Thirty-seven (10%) patients received massive transfusion (≥10 PRBCs <24 hours, table 1). Median ISS in these massively transfused patients was 34 (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). SBP in ED was 84 (75-112) mm Hg, 22 (59%) of them presented with SBP <90 mm Hg and 21 (57%) patients underwent an urgent laparotomy.…”

Section: Results Demographicsmentioning

confidence: 99%

“…1 Even though outcomes in this population were good, there is still no evidence of these concepts being successfully applied to the management of patients following blunt injury or those with TBI. 34 In search for other measures to decrease fluid resuscitation volumes in severe trauma patients, the use of vasopressors has also been described. 35 Strong support for the use of this strategy in trauma patients, however, is still lacking.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Dilemma of crystalloid resuscitation in non-exsanguinating polytrauma: what is too much?

Wessem

Hietbrink

Leenen

2020

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

BackgroundAggressive crystalloid resuscitation increases morbidity and mortality in exsanguinating patients. Polytrauma patients with severe tissue injury and subsequent inflammatory response without major blood loss also need resuscitation. This study investigated crystalloid and blood product resuscitation in non-exsanguinating polytrauma patients and studied possible adverse outcomes.MethodsA 6.5-year prospective cohort study included consecutive trauma patients admitted to a Level 1 Trauma Center intensive care unit (ICU) who survived 48 hours. Demographics, physiologic and resuscitation parameters in first 24 hours, Denver Multiple Organ Failure scores, adult respiratory distress syndrome (ARDS) data and infectious complications were prospectively collected. Patients were divided in 5 L crystalloid volume subgroups (0–5, 5–10, 10–15 and >15 L) to make clinically relevant comparisons. Data are presented as median (IQR); p value <0.05 was considered significant.Results367 patients (70% men) were included with median age of 46 (28–61) years, median Injury Severity Score was 29 (22–35) and 95% sustained blunt injuries. 17% developed multiple organ dysfunction syndrome (MODS), 4% ARDS and 14% died. Increasing injury severity, acidosis and coagulopathy were associated with more crystalloid administration. Increasing crystalloid volumes were associated with more blood products, increased ventilator days, ICU length of stay, hospital length of stay, MODS, infectious complications and mortality rates. Urgent laparotomy was found to be the most important independent predictor for crystalloid resuscitation in multinominal regression analysis. Further, fresh frozen plasma (FFP) <8 hours was less likely to be administered in patients >5 L compared with the group 0–5 L. With increasing crystalloid volume, the adjusted odds of MODS, ARDS and infectious complications increased 3–4-fold, although not statistically significant. Mortality increased 6-fold in patients who received >15 L crystalloids (p=0.03).DiscussionPolytrauma patients received large amounts of crystalloids with few FFPs <24 hours. In patients with <10 L crystalloids, <24-hour mortality and MODS rates were not influenced by crystalloid resuscitation. Mortality increased 6-fold in patients who received >15 L crystalloids ≤24 hours. Efforts should be made to balance resuscitation with modest crystalloids and sufficient amount of FFPs.Level of evidenceLevel 3.Study typePopulation-based cohort study.

show abstract

Association of Early Norepinephrine Administration With 24-Hour Mortality Among Patients With Blunt Trauma and Hemorrhagic Shock

et al. 2022

View full text Add to dashboard Cite

ImportanceHemorrhagic shock is a common cause of preventable death after injury. Vasopressor administration for patients with blunt trauma and hemorrhagic shock is often discouraged.ObjectiveTo evaluate the association of early norepinephrine administration with 24-hour mortality among patients with blunt trauma and hemorrhagic shock.Design, Setting, and ParticipantsThis retrospective, multicenter, observational cohort study used data from 3 registries in the US and France on all consecutive patients with blunt trauma from January 1, 2013, to December 31, 2018. Patients were alive on admission with hemorrhagic shock, defined by prehospital or admission systolic blood pressure less than 100 mm Hg and evidence of hemorrhage (ie, prehospital or resuscitation room transfusion of packed red blood cells, receipt of emergency treatment for hemorrhage control, transfusion of &gt;10 units of packed red blood cells in the first 24 hours, or death from hemorrhage). Blunt trauma was defined as any exposure to nonpenetrating kinetic energy, collision, or deceleration. Statistical analysis was performed from January 15, 2021, to February 22, 2022.ExposureContinuous administration of norepinephrine in the prehospital environment or resuscitation room prior to hemorrhage control, according to European guidelines.Main Outcomes and MeasuresThe primary outcome was 24-hour mortality, and the secondary outcome was in-hospital mortality. The average treatment effect (ATE) of early norepinephrine administration on 24-hour mortality was estimated according to the Rubin causal model. Inverse propensity score weighting and the doubly robust approach with 5 distinct analytical strategies were used to determine the ATE.ResultsA total of 52 568 patients were screened for inclusion, and 2164 patients (1508 men [70%]; mean [SD] age, 46 [19] years; median Injury Severity Score, 29 [IQR, 17-36]) presented with acute hemorrhage and were included. A total of 1497 patients (69.1%) required emergency hemorrhage control, 128 (5.9%) received a prehospital transfusion of packed red blood cells, and 543 (25.0%) received a massive transfusion. Norepinephrine was administered to 1498 patients (69.2%). The 24-hour mortality rate was 17.8% (385 of 2164), and the in-hospital mortality rate was 35.6% (770 of 2164). None of the 5 analytical strategies suggested any statistically significant association between norepinephrine administration and 24-hour mortality, with ATEs ranging from –4.6 (95% CI, –11.9 to 2.7) to 2.1 (95% CI, –2.1 to 6.3), or between norepinephrine administration and in-hospital mortality, with ATEs ranging from –1.3 (95% CI, –9.5 to 6.9) to 5.3 (95% CI, –2.1 to 12.8).Conclusions and RelevanceThe findings of this study suggest that early norepinephrine infusion was not associated with 24-hour or in-hospital mortality among patients with blunt trauma and hemorrhagic shock. Randomized clinical trials that study the effect of early norepinephrine administration among patients with trauma and hypotension are warranted to further assess whether norepinephrine is safe for patients with hemorrhagic shock.

show abstract

The impact of early administration of vasopressor agents for the resuscitation of severe hemorrhagic shock following blunt trauma

Cited by 13 publications

References 30 publications

Isolated liver trauma: A clinical perspective in a non‑emergency center for liver surgery

Isolated liver trauma: A clinical perspective in a non‑emergency center for liver surgery

Dilemma of crystalloid resuscitation in non-exsanguinating polytrauma: what is too much?

Association of Early Norepinephrine Administration With 24-Hour Mortality Among Patients With Blunt Trauma and Hemorrhagic Shock

Contact Info

Product

Resources

About