Preoperative fluid restriction for trauma patients with hemorrhagic shock decreases ventilator days

Abstract

AimIn recent years, with the concept of damage control resuscitation, hemostasis and preoperative fluid restriction have been carried out, but there is controversy regarding the effectiveness of fluid restriction.MethodsFrom April 2007 to March 2013, 101 trauma patients presented with hemorrhagic shock (systolic blood pressure ≤90 mmHg) at the prehospital or emergency department and were admitted to Hyogo Emergency Medical Center (Hyogo, Japan). They underwent emergency hemostasis by surgery and transcatheter arterial embolization. We compared two groups in a historical cohort study, the aggressive fluid resuscitation (AR) group, which included 59 cases treated in the period April 2007–March 2010, and the fluid restriction (FR) group, which included 42 cases treated in the period April 2010–March 2013.ResultsThere was no difference between both groups in patient background (heart rate, 110 b.p.m.; systolic blood pressure, 70 mmHg). The Injury Severity Score was 34 (AR) versus 38 (FR) (not significant). Preoperative infusion volume of crystalloid significantly decreased, from 2310 mL (AR) to 1025 mL (FR) (P ≤ 0.01). There was no difference in mortality (36% [AR] versus 41% [FR]). Ventilator days significantly decreased, from 8.5 days (AR) to 5.5 days (FR) (P = 0.02).ConclusionsPreoperative fluid restriction for trauma patients with hemorrhagic shock did not improve mortality, but it decreased ventilator days by reducing the perioperative plus water balance and it might contribute to perioperative intensive care.

The effect of restrictive fluid management on outcomes among geriatric hip fractures: a retrospective cohort study at five level I trauma centers

“… 24 Previous studies have found that those treated with preoperative SFM, and not RFM, required higher volumes of intraoperative fluid. 2 , 4 The differing results could be because of the underlying diagnoses and characteristics of trauma patients included. Matsuyama et al 4 observed that hemodynamically unstable trauma patients treated with SFM received significantly more fluids intraoperatively, but no difference in postoperative fluid volumes.…”

“…1 Previous publications reported that this standard fluid management (SFM) led to an increase in ventilator days, mortality, pulmonary edema, cerebral edema, intracranial pressure, acute respiratory distress syndrome (ARDS), development of hyperchloremic metabolic acidosis, acute kidney injury (AKI) for susceptible patients, increased hemorrhage volume, and increased time to hemostasis. 2–11 Increased time to bleeding control and increased bleeding volume for those with SFM may be attributable to hemodilution of coagulation factors, decreasing blood viscosity, detachment of the initial clot, and thrombus shift. 2–10…”

“…a Wesley Medical Center, Wichita, KS, b Injury Outcomes Network (ION) Research, Englewood, CO, c Saint Anthony's Hospital, Lakewood, CO, d Swedish Medical Center, Englewood, CO, e Penrose Hospital, Colorado Springs, CO, f Medical City Plano, Plano, TX, g South Texas Health System McAllen, McAllen, TX pulmonary edema, cerebral edema, intracranial pressure, acute respiratory distress syndrome (ARDS), development of hyperchloremic metabolic acidosis, acute kidney injury (AKI) for susceptible patients, increased hemorrhage volume, and increased time to hemostasis. [2][3][4][5][6][7][8][9][10][11] Increased time to bleeding control and increased bleeding volume for those with SFM may be attributable to hemodilution of coagulation factors, decreasing blood viscosity, detachment of the initial clot, and thrombus shift. [2][3][4][5][6][7][8][9][10] Because of these factors, there is a trend toward the use of restrictive fluid management (RFM) before hemorrhage control, as it was was previously found to be effective in reducing mortality rates for hemodynamically unstable patients or those who have penetrating injuries.…”

“…[2][3][4][5][6][7][8][9][10][11] Increased time to bleeding control and increased bleeding volume for those with SFM may be attributable to hemodilution of coagulation factors, decreasing blood viscosity, detachment of the initial clot, and thrombus shift. [2][3][4][5][6][7][8][9][10] Because of these factors, there is a trend toward the use of restrictive fluid management (RFM) before hemorrhage control, as it was was previously found to be effective in reducing mortality rates for hemodynamically unstable patients or those who have penetrating injuries. 1,3,12,13 RFM is believed to maintain a lower systolic blood pressure (SBP), termed "permissive hypotension," allowing for adequate vasoconstriction and prevention of undesired coagulopathy.…”

“…2–11 Increased time to bleeding control and increased bleeding volume for those with SFM may be attributable to hemodilution of coagulation factors, decreasing blood viscosity, detachment of the initial clot, and thrombus shift. 2–10…”