Hypotensive Resuscitation and Mortality

Dr. Dong

Hypotensive Resuscitation during Active Hemorrhage: Impact on In-Hospital Mortality

Dutton MD, Mackenzie MD, Scalea MD

J Trauma 2005

This article focuses on the latest strategies to improve the outcomes of patients suffering from acute hemorrhagic shock as a result of trauma. It aims to support findings from a study done in the early 1990’s from Houston which proposed the idea of holding intravenous crystalloids and allowing permissive hypotension until the active source of bleeding is located and resolved. However the authors at the University of Maryland Shock Trauma Center noted multiple shortcomings from the previous study and embarked on a mission to re-create the aforementioned trend. 110 patients were reenrolled over 20 months, in which 55 were placed in a group with an average SBP being 114mmHg and the other 100mmHg. Variables such as injury severity score, and duration of hemorrhage were similar between the groups. In the end however, both groups demonstrated similar outcomes in which survivability was 92.7% in each group with 4 deaths each. The article mentions that the possible reasons for the lack of differentiation could have been improvements in the overall diagnostic and theurapeutic technology, short duration of the study, major difference in the mechanism of trauma and the imprecision of manual SBP readings.