Permissive Hypotension for Trauma Resuscitation
, October 01, 2002
"Please mark my word. Within no less than 10 years, probably even less than 5 years, any[one] that raises the blood pressure to higher than 3/4 the pre injury level,…
, May 10, 2011
This year's London Trauma Conference and Masterclass Symposia will be held at the Royal Geographical Society in Kensington on 22-24th June 2011. TRAUMA.ORG is cohosting this conference in what is one of the premier meetings on the global trauma calendar and deliver an outstanding scientific and practical symposium on the state of the art in trauma care. Once again the main programme will feature keynote speakers challenged to answer the difficult questions in trauma care. This year's special sessions will include a 'Trauma Systems' master class, 'Prehospital Care conference for students, 'Core Topics for Junior Doctors'. On the 22nd June the London Trauma Research Forum is holding a special conjoined session with the meeting. The London Trauma Conference will change your practice.
Karim, London, UK, June 05, 2009
PubMed ID: 7935634
N Engl J Med. 1994 Oct 27;331(17):1105-9
Authors: Bickell WH, Wall MJ Jr, Pepe PE, Martin RR, Ginger VF, Allen MK, Mattox KL
Abstract:
BACKGROUND. Fluid resuscitation may be detrimental when given before bleeding is controlled in patients with trauma. The purpose of this study was to determine the effects of delaying fluid resuscitation until the time of operative intervention in hypotensive patients with penetrating injuries to the torso.
METHODS. We conducted a prospective trial comparing immediate and delayed fluid resuscitation in 598 adults with penetrating torso injuries who presented with a pre-hospital systolic blood pressure of < or = 90 mm Hg. The study setting was a city with a single centralized system of pre-hospital emergency care and a single receiving facility for patients with major trauma. Patients assigned to the immediate-resuscitation group received standard fluid resuscitation before they reached the hospital and in the trauma center, and those assigned to the delayed-resuscitation group received intravenous cannulation but no fluid resuscitation until they reached the operating room.
RESULTS. Among the 289 patients who received delayed fluid resuscitation, 203 (70 percent) survived and were discharged from the hospital, as compared with 193 of the 309 patients (62 percent) who received immediate fluid resuscitation (P = 0.04). The mean estimated intraoperative blood loss was similar in the two groups. Among the 238 patients in the delayed-resuscitation group who survived to the postoperative period, 55 (23 percent) had one or more complications (adult respiratory distress syndrome, sepsis syndrome, acute renal failure, coagulopathy, wound infection, and pneumonia), as compared with 69 of the 227 patients (30 percent) in the immediate-resuscitation group (P = 0.08). The duration of hospitalization was shorter in the delayed-resuscitation group.
CONCLUSIONS. For hypotensive patients with penetrating torso injuries, delay of aggressive fluid resuscitation until operative intervention improves the outcome.
