Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

Hypotensive Resuscitation

No description
by

Ross Hofmeyr

on 15 January 2016

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of Hypotensive Resuscitation

Between Scylla and Charybdis..
.
...is there a role for hypotensive resuscitation
in South African trauma patients?
Exsanguination
Hypotensive
Shock
Coagulopathy
Tissue
Hypoxia
Acidosis
Patient
Anaesthetist
Concept
Concerns
Context
Conduct
Hypotensive resuscitation = Permissive hypotension
"Use of a restrictive fluid strategy, especially in trauma"
(sometimes called deliberate hypotension)
"DON'T
POP
Aggressive fluid administration:
Raised BP
Coagulation factor dilution
Decreased Hct & blood viscosity
Hypothermia
THE
CLOT"
Ischaemia -> interstitial oedema -> 'no-reflow' phenomenon
Irreversible ischaemia even despite macrocirculatory recovery
Increased
haemorrhage
Normal MAP 70-100mmHg
Bickell et al, 1994
RCT, N=598
No fluid prehospital vs. standard
care (2000ml N/S)
TBI excluded
Dutton et al, 2002
RCT, N=110
SBP target 70 vs 100 mmHg
(Fluid given in titrated boluses)
TBI excluded
Survival 62 % vs 70 % (p=0.04)
Survival identical (SBP 70 vs 100)
2003
Favors hypotension
Favors normotension
J Trauma 2011
Morrison et al, 2011
I
ntraoperative
permissive hypotension
RCT, N=90
MAP target 50 vs 65 mmHg

Excluded:
Age <14 or >45
Traumatic brain injury
Known CAD/IHD/renal/CVD
Pregnancy

Ross Hofmeyr
No conflicts of interest
Presentation online at tinyurl.com/HypotensiveResus
DCR
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
Rapid presentation
Early surgery planned
Absence of TBI
Absence of comorbidities
(Maybe blunt trauma)
SBP 80, MAP 50 mmHg
Avoid 'three-digit reflex'
Haemostatic resus
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...

...to strive,
to seek,
to find,
and not to yield

SBP <90
150% increase in mortality
(Chesnut 1993 - J Trauma)
Full transcript