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Noninvasive and Invasive Renal Hypoxia Monitoring in a Porcine Model of Hemorrhagic Shock
Published on: October 28, 2022
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Vasopressors in Trauma: A Never Event?
Justin E Richards1, Tim Harris2,3, Martin W Dünser4
1From the Department of Anesthesiology, University of Maryland School of Medicine, Divisions of Trauma Anesthesiology and Critical Care Medicine, R Adams Cowley Shock Trauma Center, Baltimore, Maryland.
Anesthesia and Analgesia
|April 28, 2021
Summary
Vasopressors may aid traumatic shock resuscitation by counteracting vasodilation, challenging the traditional hypotensive resuscitation approach. A balanced strategy is needed for optimal outcomes in trauma patients.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Critical Care
Background:
- Vasopressor use in trauma is debated due to concerns of worsened organ perfusion and mortality.
- Hypotensive resuscitation is advocated but lacks robust clinical data.
- Traumatic shock involves complex neurohormonal responses, including phases of vasoconstriction and vasodilation.
Purpose of the Study:
- To discuss the controversy surrounding vasopressor administration in hypotensive trauma patients.
- To advocate for a nuanced approach to vasopressor use in traumatic shock resuscitation.
Main Methods:
- Review of pathophysiology of traumatic shock.
- Analysis of current resuscitation strategies and their limitations.
- Discussion of potential benefits of vasopressors in specific trauma scenarios.
Main Results:
- Hypotension in hemorrhagic shock reflects a vasodilation phase, not just hypovolemia.
- Persistent hypotension and hypoperfusion correlate with worse coagulopathy and organ function.
- Excessive volume resuscitation can lead to adverse outcomes.
Conclusions:
- The practice of hypotensive resuscitation is counterintuitive and not consistently supported by data.
- Vasopressors may be beneficial in managing vasodilation associated with hemorrhage and other conditions in trauma.
- A balanced approach targeting both intravascular volume and vascular tone is crucial for effective traumatic shock resuscitation.
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