Rethinking vasopressor use in the trauma bay: a shifting perspective

The use of vasopressors during the acute resuscitation of severely injured patients with trauma has long been controversial. Building on the concept of permissive hypotension, damage control resuscitation focuses on hemostatic transfusion of blood products to maintain perfusion pressures. However, targeting lower perfusion pressures while awaiting definitive hemorrhage control is contraindicated in some patient subpopulations and may be detrimental. Coupled with the shift towards a circulation-first approach to resuscitation, there is increasing interest in the use of vasopressors in the trauma bay. This narrative review aims to summarize the evidence behind trauma bay vasopressors and identify the potential role of vasoactive medications in the early phases of trauma care.