Efficacy comparison of restrictive versus massive fluid resuscitation in patients with traumatic hemorrhagic shock

To compare the therapeutic effect and safety of restrictive versus massive fluid resuscitation in patients with traumatic hemorrhagic shock (TSH).

Ninety TSH patients treated in the ICU of the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2020 to January 2021 were recruited for this retrospective study. Among them, 47 cases received restrictive fluid resuscitation (RFR) after admission who were considered as the observation group (OG), while the other 43 cases were given massive fluid resuscitation (MFR) who were treated as the control group (CG). The clinical indices, coagulation function, blood gas analysis, mortality within 72 h, duration of mechanical ventilation, and ICU stay were compared between the two groups, and the amount of resuscitation fluid given and complications that occurred during treatment were recorded. Multivariate logistic regression analysis was used to screen the independent risk factors for complications.

In comparison to the CG, the resuscitation time, infusion volume, and lactate level in the OG were lower after treatment, while the hemoglobin level and blood gas residual base value (BE) were higher. Besides, the activated partial thromboplastin time (APTT), thrombin time (TT) and prothrombin time (PT) levels and arterial blood carbon dioxide partial pressure (PaCO₂) in the OG were lower, while arterial blood oxygen partial pressure (PaO₂) and pH were higher. The duration of mechanical ventilation and ICU stay in the OG after treatment were lower, and there was no statistical difference in mortality and complication rates within 72 h. Lower mean arterial pressure (MAP), higher APACHE II (Acute Physiology and Chronic Health Evaluation II) and longer resuscitation time were independent risk factors for complications in patients with traumatic shock.

TSH treatment with RFR can effectively accelerate patients' resuscitation with less volume of infusion of resuscitation fluid, reduced time of mechanical ventilation and ICU hospitalization, and promote the recovery of coagulation function. It has good effects and is very suitable for clinical application.