Fluid Resuscitation Strategies: A Systematic Review of Animal Trials

Mapstone, James; Roberts, Ian; Evans, P A

doi:10.1097/01.ta.0000062968.69867.6f

Cited by 173 publications

(127 citation statements)

References 37 publications

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“…The mortality rate (7.3%) was the same for both groups of patients. However, comparison of Injury Severity Scores 26 indicated that patients in the low group (scores, [16][17][18][19][20][21][22][23][24] were more severely injured (P = .02) than were patients in the conventional group (scores, 9-15). Thus, permissive hypotensive resuscitation may benefit restoration of blood circulation and cause a modest increase in blood pressure (reducing the risk of additional blood loss due to continued bleeding or rebleeding) with minimal fluid requirements.…”

Section: Studies Of Permissive Hypotension In Humansmentioning

confidence: 95%

“…18 Aggressive fluid resuscitation may reverse vasoconstriction by replacing volume, displace early formed thrombus by increasing blood flow, and therefore magnify the establishment of coagulopathy due to hypovolemic shock. 20 A systematic meta-analysis of preclinical data (52 animal trials) 21 indicated an increased adjusted relative risk of death, from 0.69 to 1.80, when aggressive resuscitation was used in animals with less severe hemorrhage (ie, tail resection). In other trials, 16,17 attempts to increase MAP to 80 mm Hg with fluid resuscitation in animals with established hypovolemic shock were associated with decreased oxygen supply to the tissues, metabolic acidosis, and a poor outcome.…”

Section: Experimental Assessment Of Permissive Hypotension In Animalsmentioning

confidence: 99%

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Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

Gourgiotis

Gemenetzis

Kocher

et al. 2013

Critical Care Nurse

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T rauma remains the leading cause of mortality among persons 1 to 44 years old in the United States 1 and accounts for almost 9% of total mortality worldwide. 2 In 2008 a total of 663000 injury-related deaths occurred in Europe (6.9% of total deaths). 2 Uncontrolled bleeding and exsanguination are the leading cause of preventable death after trauma 3 and require early detection of potential bleeding sources and prompt action to minimize blood loss, restore tissue perfusion, and achieve a stable hemodynamic status. Permissive Hypotension in CNE Continuing Nursing EducationCover Severity of hemorrhage and rate of bleeding are fundamental factors in the outcomes of trauma. Intravenous administration of fluid is the basic treatment to maintain blood pressure until bleeding is controlled. The main guideline, used almost worldwide, Advanced Trauma Life Support, established by the American College of Surgeons in 1976, calls for aggressive administration of intravenous fluids, primarily crystalloid solutions. Several other guidelines, such as Prehospital Trauma Life Support, Trauma Evaluation and Management, and Advanced Trauma Operative Management, are applied according to a patient's current condition. However, the ideal strategy remains unclear. With permissive hypotension, also known as hypotensive resuscitation, fluid administration is less aggressive. The available models of permissive hypotension are based on hypotheses in hypovolemic physiology and restricted clinical trials in animals. Before these models can be used in patients, randomized, controlled clinical trials are necessary. (Critical Care Nurse. 2013;33[6]:18-25)

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Section: Studies Of Permissive Hypotension In Humansmentioning

confidence: 95%

Section: Experimental Assessment Of Permissive Hypotension In Animalsmentioning

confidence: 99%

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

Gourgiotis

Gemenetzis

Kocher

et al. 2013

Critical Care Nurse

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“…This hypotensive approach has been adopted in civilian [6] and military [7] authority publications, advocating limited initial fluid resuscitation to resuscitate the trauma casualty in order to maintain a target systolic blood pressure of 80 mmHg (approximating to a palpable radial pulse). A systematic review of animal studies concluded that all the studies of hypotensive resuscitation strategies reduced the risk of death when compared with normotensive strategies [8]. However, the vascular injury used (e.g.…”

Section: Volume Resuscitation In Major Traumamentioning

confidence: 99%

Resuscitation and coagulation in the severely injured trauma patient

Midwinter

Woolley

2011

Phil. Trans. R. Soc. B

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Developments in the resuscitation of the severely injured trauma patient in the last decade have been through the increased understanding of the early pathophysiological consequences of injury together with some observations and experiences of recent casualties of conflict. In particular, the recognition of early derangements of haemostasis with hypocoagulopathy being associated with increased mortality and morbidity and the prime importance of tissue hypoperfusion as a central driver to this process in this population of patients has led to new resuscitation strategies. These strategies have focused on haemostatic resuscitation and the development of the ideas of damage control resuscitation and damage control surgery continuum. This in turn has led to a requirement to be able to more closely monitor the physiological status, of major trauma patients, including their coagulation status, and react in an anticipatory fashion.

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“…Patients with penetrating truncal trauma, in which resuscitation was delayed, had a higher survival rate to discharge (70%) compared with promptly resuscitated patients (62%, P = 0.04) [4]. Likewise, a systemic review of animal studies [5] has also shown a lower risk of death in animals resuscitated to hypotensive levels than in animals resuscitated to normotensive levels (P \ 0.00001). The small volume resuscitation with fluids such as hypertonic saline [6] or albumin 25% [7] has similarly shown a higher survival rate compared with infusion of isotonic fluids.…”

mentioning

confidence: 98%

“…Recently, the importance of limited resuscitation [4][5][6][7] has been widely acknowledged. Patients with penetrating truncal trauma, in which resuscitation was delayed, had a higher survival rate to discharge (70%) compared with promptly resuscitated patients (62%, P = 0.04) [4].…”

mentioning

confidence: 99%

Progressive hemorrhage: administer oxygen or early resuscitation?

Douzinas

2009

Intensive Care Med

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Hemorrhage is one of the main causes responsible for the impairment of blood flow, with subsequent tissue hypoperfusion and hypoxia. As the circulating blood volume decreases, oxygen consumption (VO 2 ) remains constant for a considerable amount of blood loss. When the oxygen delivery (DO 2 ) drops below a critical level, i.e. 10 mL O 2 / min per kg, VO 2 falls abruptly. This signifies a blood volume loss of approximately 50%, associated with substantial reduction in cardiac output and mixed venous oxygen saturation [1]. At this stage of ischemia, deep tissue hypoxia leads the severely O 2 -deprived cell to prime for generation of ROS, upon O 2 re-entry during reperfusion [2]. Cellular priming consists of ATP depletion, since ATP degrades, reaching the level of hypoxanthine with concurrent xanthine oxidase accumulation. This situation is associated with either absolute O 2 restriction (no-flow state) or prolonged O 2 debt (low flow state) [3]. The profuse and sudden oxygen re-entry at resuscitation acts as a cofactor, allowing xanthine oxidase to convert hypoxanthine to uric acid. The resulting by-products are superoxide anions (O 2 -) and hydrogen peroxide (H 2 O 2 ), representing the main molecules of the initial oxidative burst [2]. The aforementioned reactive oxygen species, along with the free radicals generated by NADPH oxidase within the neutrophils, attack peroxidating cell membranes. Consequently, ischemia/ reperfusion injury occurs, the global equivalent of which is hemorrhagic shock and resuscitation.Recently, the importance of limited resuscitation [4-7] has been widely acknowledged. Patients with penetrating truncal trauma, in which resuscitation was delayed, had a higher survival rate to discharge (70%) compared with promptly resuscitated patients (62%, P = 0.04) [4]. Likewise, a systemic review of animal studies [5] has also shown a lower risk of death in animals resuscitated to hypotensive levels than in animals resuscitated to normotensive levels (P \ 0.00001). The small volume resuscitation with fluids such as hypertonic saline [6] or albumin 25% [7] has similarly shown a higher survival rate compared with infusion of isotonic fluids.The approach of attempting to lessen reperfusion injury by adjusting the inspired O 2 may apply either before [8] or during [9-12] resuscitation. As far as the first case is concerned, the impact of inspired oxygen concentration on tissue oxygenation (tPO 2 ) in the absence of resuscitation was the subject of a study from Dyson et al. [8], published in this issue of the journal. The latter case is represented by hypoxemic resuscitation [9][10][11][12]; a process in which hypoxemia is applied during the first few minutes of resuscitation and, as shock reverses, it gradually turns to normoxemia.In the aforementioned study [8], tissue oxygenation improves at mild (less than 20%) blood volume losses similarly to normovolemia, in response to higher inspired oxygen admixtures. Adversely, at significant (more than 50%) blood volume losses, higher inspired oxygen admixture...

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Fluid Resuscitation Strategies: A Systematic Review of Animal Trials

Cited by 173 publications

References 37 publications

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

Resuscitation and coagulation in the severely injured trauma patient

Progressive hemorrhage: administer oxygen or early resuscitation?

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