Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis

Abstract

BackgroundDamage control strategies play an important role in trauma patient management. One such strategy, hypotensive resuscitation, is being increasingly employed. Although several randomized controlled trials have reported its benefits, the mortality benefit of hypotensive resuscitation has not yet been systematically reviewed.ObjectivesTo conduct a meta-analysis of the efficacy of hypotensive resuscitation in traumatic hemorrhagic shock patients relative to mortality as the primary outcome, with acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and multiple organ dysfunction as the secondary outcomes.MethodsPubMed, Medline-Ovid, Scopus, Science Direct, EMBASE, and CNKI database searches were conducted. An additional search of relevant primary literature and review articles was also performed. Randomized controlled trials and cohort studies reporting the mortality rate associated with hypotensive resuscitation or limited fluid resuscitation were selected. The random-effects model was used to estimate mortality and onset of other complications.ResultsOf 2114 studies, 30 were selected for this meta-analysis. A statistically significant decrease in mortality was observed in the hypotensive resuscitation group (risk ratio [RR]: 0.50; 95% confidence interval [CI]: 0.40–0.61). Heterogeneity was observed in the included literature (I2: 27%; degrees of freedom: 23; p = 0.11). Less usage of packed red cell transfusions and fluid resuscitations was also demonstrated. No significant difference between groups was observed for AKI; however, a protective effect was observed relative to both multiple organ dysfunction and ARDS.ConclusionsThis meta-analysis revealed significant benefits of hypotensive resuscitation relative to mortality in traumatic hemorrhagic shock patients. It not only reduced the need for blood transfusions and the incidences of ARDS and multiple organ dysfunction, but it caused a non-significant AKI incidence.

Risk of in-hospital mortality in severe acute kidney injury after traumatic injuries: a national trauma quality program study

“…A recent meta-analysis of the current evidence on this subject suggests that hypotensive resuscitation in the appropriately selected patients may have some mortality benefit without excessive risk of AKI. 14 Another approach to hemorrhagic trauma patients can be damage control resuscitation, which includes controlling of hemorrhage, replacement of lost blood and preventing coagulopathy can be applied to reduce the incidence of mortality. 15 Thus, more evaluation of the interaction of hemodynamics and AKI in trauma patients is required to identify appropriate management measures around these characteristics.…”

Prehospital and Emergency Care in Adult Patients with Acute Traumatic Brain Injury

“…Shock and arterial hypotension after TBI may be an indicator for supplementary organ lesions, and a search for supplementary lesions should be performed immediately, as about one third of TBI patients are patients with multiple trauma [5]. A meta-analysis observed a lower mortality in patients with traumatic hemorrhagic shock, receiving hypotensive resuscitation [61].…”

A Nomogram Based on Clinical Characteristics for Predicting Multiple Organ Dysfunction Syndrome(MODS) Following Multiple Trauma Patients

“…It is well known that hemorrhagic shock is a frequently complication in severe multiple trauma patients,which may lead to MODS even death.Hemorrhagic shock has been proposed as an main driver of systemic in ammation,gut barrier disruption,endothelial damage and coagulation dysfunction,all these factors may contributed to the development of MODS [25] .A animal model experiment demonstrated that hemorrhagic shock add to the systemic in ammatory reaction early after multiple trauma,aggravate pulmonary damage and worsen renal and endothelial function,which might lead to the development of early multiple organ dysfunction syndrome [26] .Furthermore,it is by now generally accepted that hemorrhagic shock induced a vicious cycle of outcomes,consisting of hypothermia,acidosis,and coagulopathy-otherwise known as the lethal triad [27] .Besides,hemorrhagic shock can lead to a imbalance between oxygen supply and consumption,and this anoxia result in a change from aerobic to anaerobic metabolism.Lactic acidosis ensues,and if uncorrected,MODS and death follow [28] .Consequently,we regarded hemorrhagic shock as a crucial predictor for developing MODS.…”