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Transcript of Hypotensive Resuscitation
...is there a role for hypotensive resuscitation
in South African trauma patients?
Hypotensive resuscitation = Permissive hypotension
"Use of a restrictive fluid strategy, especially in trauma"
(sometimes called deliberate hypotension)
Aggressive fluid administration:
Coagulation factor dilution
Decreased Hct & blood viscosity
Ischaemia -> interstitial oedema -> 'no-reflow' phenomenon
Irreversible ischaemia even despite macrocirculatory recovery
Normal MAP 70-100mmHg
Bickell et al, 1994
No fluid prehospital vs. standard
care (2000ml N/S)
Dutton et al, 2002
SBP target 70 vs 100 mmHg
(Fluid given in titrated boluses)
Survival 62 % vs 70 % (p=0.04)
Survival identical (SBP 70 vs 100)
J Trauma 2011
Morrison et al, 2011
MAP target 50 vs 65 mmHg
Age <14 or >45
Traumatic brain injury
No conflicts of interest
Presentation online at tinyurl.com/HypotensiveResus
Damage Control Resuscitation
J Trauma 2012
US Military: SBP 50; SBP 70 if LOC is decreased
UK: SBP 80-90; SBP 60 in torso trauma if alert
Israeli Military: SBP 50; SBP 70 if LOC decreased
Shoud we practice hypotensive resuscitation?
If so, when should we use it?
What should we target?
What is next?
Penetrating trunk trauma
Early surgery planned
Absence of TBI
Absence of comorbidities
(Maybe blunt trauma)
SBP 80, MAP 50 mmHg
Avoid 'three-digit reflex'
Yet all experience is an arch wherethro'
Gleams that untravell'd world whose margin fades
For ever and forever when I move.
There lies the port; the vessel puffs her sail...
and not to yield
150% increase in mortality
(Chesnut 1993 - J Trauma)