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Permissive hypotensive resuscitation--an evolving concept in trauma
1Trauma Program and Surgical Intensive Care Unit, Division of Trauma Surgery and Surgical Critical Care, Medical College of Ohio Hospitals, 3065 Arlington Avenue, Toledo, OH 43614, USA.
JPMA. the Journal of the Pakistan Medical Association
|October 6, 2004
Summary
Trauma fluid resuscitation is debated. Judicious fluid administration to maintain mean arterial pressure (MAP) between 60-80 mmHg is recommended, balancing risks of over-resuscitation and under-resuscitation.
Area of Science:
- Trauma Surgery
- Critical Care Medicine
- Emergency Medicine
Background:
- Fluid resuscitation in trauma remains controversial, with evidence suggesting potential harm from aggressive administration.
- Both excessive and insufficient fluid resuscitation carry significant risks, including increased mortality and organ failure.
Purpose of the Study:
- To review the current evidence and expert opinion on optimal fluid resuscitation strategies in trauma patients.
- To highlight the challenges in balancing fluid administration for hemodynamic stability versus risks of exacerbating hemorrhage.
Main Methods:
- Review of experimental evidence and current clinical practices in trauma fluid resuscitation.
- Discussion of the potential benefits and harms associated with different resuscitation approaches.
Main Results:
- Aggressive crystalloid administration in uncontrolled hemorrhage can increase bleeding and mortality.
- Avoiding fluids may lead to hypoperfusion, organ failure, and adverse neurologic outcomes in traumatic brain injury (TBI).
Conclusions:
- Optimal trauma resuscitation requires a judicious approach, avoiding both "too much too early" and "too little too late" fluid administration.
- Maintaining mean arterial pressure (MAP) within the 60-80 mmHg range is a widely accepted strategy.
- Fluid resuscitation is a temporizing measure, not definitive therapy, emphasizing the need for timely surgical bleeding control.