Skip to main content
SpringerLink
Log in

Hypotensive Resuscitation in Penetrating Trauma: Rules of the Game

  • Chapter
  • First Online:
Penetrating Trauma

  • 2360 Accesses

Abstract

Adaptation to a changing world and the need to revisit our philosophy of fluid resuscitation grew out of a practical necessity as studies have repetitively demonstrated that early and aggressive crystalloid resuscitation is not without consequence. Trauma surgeons were faced with the very real fact of the detrimental results of fluid overload, including ARDS; SIRS and MSOF have, for many, become the end product of over-resuscitation. An overwhelming amount of supportive studies have demonstrated that hypotensive resuscitation is likely beneficial in penetrating mechanisms of trauma. Thus, resuscitative efforts begin after surgical hemostasis, or temporizing methods, have been achieved. Once operative control of bleeding has been obtained, resuscitation to endpoints of adequate tissue perfusion should be achieved.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 179.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Alam HB, Shults C, Ahuja N, Ayuste EC, Chen H, Koustova E, Sailhamer EA, Li Y, Liu B, de Moya M, de Velmahos GC (2008) Impact of resuscitation strategies on the acetylation status of cardiac histones in a swine model of hemorrhage. Resuscitation 76:299–310

    Article  PubMed  Google Scholar 

  2. Beekley AC (2008) Damage control resuscitation: a sensible approach to the exsanguinating surgical patient. Crit Care Med 36(7 suppl):267–274

    Article  Google Scholar 

  3. Mattox KL, Bickell WH, Pepe PE, Mangelsdorff AD (1986) Prospective randomized evaluation of antishock MAST in post-traumatic hypotension. J Trauma 26(9):779–786

    Article  PubMed  CAS  Google Scholar 

  4. Nicholl J, Hughes S, Dixon S, Turner J, Yates D (1998) The costs and benefits of paramedic skills in pre-hospital trauma care. Health Technol Assess 2(17):30

    Google Scholar 

  5. Bickell WH, Wall MJ, Pepe PE, Martin RR, Ginger VF, Allen MK, Mattox KL (1994) Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 331(17):1105–1109

    Article  PubMed  CAS  Google Scholar 

  6. Blair SD, Janvrin SB, McCollum CN, Greenhalgh RM (1986) Effect of early blood transfusion on gastrointestinal hemorrhage. Br J Surg 73(10):783–785

    Article  PubMed  CAS  Google Scholar 

  7. Dutton RP, MacKenzie CF, Scalea TM (2002) Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. J Trauma 52:1141–1146

    Article  PubMed  Google Scholar 

  8. Peitzman AB, Billiar TR, Harbrecht BG (1995) Hemoorrhagic shock. Curr Probl Surg 32:974

    Article  Google Scholar 

  9. Kauvar DS, Lefering R, Wade CE (2006) Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma 60(6):3–11

    Article  Google Scholar 

  10. Capone AC, Safar P, Stezoski W, Tisherman S, Peitzman AB (1995) Improved outcome with fluid restriction in treatment of uncontrolled hemorrhagic shock. J Am Coll Surg 180(1):49–56

    PubMed  CAS  Google Scholar 

  11. Krausz MM (2006) Initial resuscitation of hemorrhagic shock. World J Emerg Surg 1(14):1–5

    Google Scholar 

  12. Kreimeier U, Prueckner S, Peter K (2000) Permissive hypotension. J Suisse Med 130(42):1516–1524

    CAS  Google Scholar 

  13. Hirshberg A, Hoyt DB, Mattox KL (2006) Timing of fluid resuscitation shapes the hemodynamic response to uncontrolled hemorrhage: analysis using dynamic modeling. J Trauma 60:1221–1227

    Article  PubMed  Google Scholar 

  14. Hirshberg A, Hoyt DB, Mattox KL (2007) From ‘leaky buckets’ to vascular injuries: understanding models of uncontrolled hemorrhage. J Am Coll Surg 204(4):665–672

    Article  PubMed  Google Scholar 

  15. Hoyt DB (2003) Fluid resuscitation: the target from an analysis of trauma systems and patient survival. J Trauma 54(5):31–35

    Google Scholar 

  16. Ferreira ELA, Terzi RGG, Silva WA, Moraes AC (2005) Early colloid replacement therapy in a near-fatal model of hemorrhagic shock. Anesth Analg 101:1785–1791

    Article  PubMed  CAS  Google Scholar 

  17. Dubick MA, Atkins JL (2003) Small-volume fluid resuscitation for the far-forward combat environment: current concepts. J Trauma 54(5):43–45

    Google Scholar 

  18. Rafie AD, Rath PA, Michell MW, Kirschner RA, Deyo DJ, Prough DS, Grady JJ, Kramer GC (2004) Hypotensive resuscitation of multiple hemorrhages using crystalloid and colloids. Shock 22(3):262–269

    Article  PubMed  Google Scholar 

  19. Shultz C, Sailhamer EA, Li Y, Liu B, Tabbara M, Butt MU, Shuja F, de Moya M, Velmahos G, Alam HB (2008) Surviving blood loss without fluid resuscitation. J Trauma 64(3):629–640

    Article  Google Scholar 

  20. McNeil JD, Smith DL, Jenkins DH, York GB, Josephs JD (2001) Hypotensive resuscitation using a polymerized bovine hemoglobin-based oxygen-carrying solution (HBOC-201) leads to reversal of anaerobic metabolism. J Trauma 50(6):1063–1075

    Article  PubMed  CAS  Google Scholar 

  21. Rushing GD, Britt LD (2008) Reperfusion injury after hemorrhage. Ann Surg 247(6):929–937

    Article  PubMed  CAS  Google Scholar 

  22. Sampson JB, Davis MR, Mueller DL, Kashyap VS, Jenkins DH, Kerby JD (2003) A comparison of the hemoglobin-based oxygen carrier HBOC-201 to other low-volume resuscitation fluids in a model of controlled hemorrhagic shock. J Trauma 55(4):747–754

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Surgical Critical Care, Boston Medical Center, Boston, MA, 02118, USA

    Suresh Agarwal

  2. Department of Surgery, Boston University School of Medicine, 850 Harrison Avenue, Dowling 2 South, Boston, MA, 02118, USA

    Suresh Agarwal & Peter Burke

  3. Department of Surgery, Boston Medical Center, Boston, MA, 02118, USA

    Lejla Hadzikadic

  4. Trauma Services, Boston Medical Center, Boston, MA, USA

    Peter Burke

Authors
  1. Suresh Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lejla Hadzikadic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Burke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Suresh Agarwal .

Editor information

Editors and Affiliations

  1. Dept. Surgery, Massachusetts General Hospital, Fruit Street 55, Boston, 02114, Massachusetts, USA

    George C. Velmahos

  2. Medical School, Dept. Surgery, University of Witwatersrand, York Road 7, Johannesburg, 2193, South Africa

    Elias Degiannis

  3. Klinik für Viszeral-, Thorax- und, Gefäßchirurgie, Univ.Klinikum Marburg, Baldingerstraße, Marburg, 35043, Germany

    Dietrich Doll

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Berlin Heidelberg

About this chapter

Cite this chapter

Agarwal, S., Hadzikadic, L., Burke, P. (2012). Hypotensive Resuscitation in Penetrating Trauma: Rules of the Game. In: Velmahos, G., Degiannis, E., Doll, D. (eds) Penetrating Trauma. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-20453-1_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-20453-1_3

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-20452-4

  • Online ISBN: 978-3-642-20453-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation