scholarly journals Permissive Hypotension vs. Conventional Resuscitation in Patients With Trauma or Hemorrhagic Shock: A Review

Cureus ◽  
2021 ◽  
Author(s):  
Leah Woodward ◽  
Mohammed Alsabri
Keyword(s):  
Hemorrhagic Shock ◽  
Permissive Hypotension

Anesthetic management of a patient with hollow viscus perforation due to blunt abdominal trauma with grade IV hemorrhagic shock

2021 ◽  
Vol 25 (2) ◽  
Author(s):  
Reza Widianto Sudjud ◽  
Djoni Kusumah Pohan ◽  
Muhammad Budi Kurniawan ◽  
Hana Nur Ramila
Keyword(s):  
Hemorrhagic Shock ◽  
Blunt Abdominal Trauma ◽  
Massive Transfusion ◽  
Damage Control ◽  
Anesthetic Management ◽  
Hollow Viscus ◽  
Permissive Hypotension ◽  
Massive Transfusion Protocol ◽  
Transfusion Protocol ◽  
Hollow Viscus Perforation

Hemorrhagic shock is a form of hypovolemic shock in which severe blood loss leads to inadequate oxygen delivery at the cellular level. Death from hemorrhage represents a substantial global problem, with more than 60,000 deaths per year in the United States and an estimated 1.9 million deaths per year worldwide, 1.5 million of which result from physical trauma. This case report aims to stress the need of handling cases of hemorrhagic shock in accordance with damage control protocol. Hemorrhagic shock management using permissive hypotension management, bleeding control, massive transfusion protocol (MTP), minimal crystalloid therapy, and adjuvant therapy is the best approach to get optimal outcome to prevent triad of death. In this case, the application of damage control resuscitation has not been fully implemented because of several constraints. Key words: Hemorrhage; Hemorrhagic shock; Permissive hypotension; Massive Transfusion Protocol; MTP; Resuscitation; Damage control Citation: Pohan DK, Sudjud RW, Kurniawan MB, Ramila HN. Anesthetic management on patient with hollow viscus perforation due to blunt abdominal trauma with grade IV hemorrhagic shock. Anaesth. pain intensive care 2021;25(2):217-221. DOI: 10.35975/apic.v25i2.1474 Received: 11 January 2021, Reviewed: 15 January 2021, Accepted: 16 February 2021

Permissive hypotension versus conventional resuscitation strategies in adult trauma patients with hemorrhagic shock

2018 ◽  
Vol 84 (5) ◽  
pp. 802-808 ◽  
Author(s):  
Alexandre Tran ◽  
Jeffrey Yates ◽  
Aaron Lau ◽  
Jacinthe Lampron ◽  
Maher Matar
Keyword(s):  
Hemorrhagic Shock ◽  
Trauma Patients ◽  
Permissive Hypotension

scholarly journals Comparison of Permissive Hypotension vs. Conventional Resuscitation Strategies in Adult Trauma Patients with Hemorrhagic Shock: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.

2021 ◽  
Author(s):  
Yang Zhang ◽  
Yaping Ding ◽  
Dongbin Zheng ◽  
Xusheng Huang ◽  
Junhui Zhang ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Randomized Controlled Trials ◽  
Hemorrhagic Shock ◽  
Fluid Resuscitation ◽  
Meta Analysis ◽  
Intervention Group ◽  
Systolic Pressure ◽  
Controlled Trials ◽  
Permissive Hypotension ◽  
Randomized Controlled

Abstract BackgroundThere is still an ongoing battle against the Permissive Hypotension (PH) through Conventional Resuscitation Strategies (CR). Active fluid resuscitation in patients with traumatic shock can bring many problems, as it is known that standard high-volume resuscitation can exacerbate the lethal triad of acidemia, hypothermia, and coagulopathy. As a part of damage control resuscitation strategy, it can reduce mortality and shorten hospital stay, compared with the use of standard liquids. Moreover, its application is gradually receiving wider attention (1) . This review evaluated the effectiveness and safety of permissive hypotension resuscitation in adult patients with traumatic hemorrhagic shock.MethodsThe systematic review and meta-analysis were conducted according to PRISMA guidelines. We searched PubMed, EMBASE and Cochrane databases for randomized controlled trials (RCTs) from the beginning to March 2021 to compare the therapeutic effects of controlled fluid resuscitation and conventional fluid resuscitation on patients with traumatic hemorrhagic shock. Two reviewers independently conducted screening, data extraction and bias assessment. Data analysis was performed using Cochrane Collaboration Software Revman 5.2. The primary outcome was 30-day or in-hospital mortality. Secondary outcomes included blood routine index, coagulation function, resuscitation fluid use, complications, and length of hospital stay. Pooling was performed with a random-effects model.Results8 randomized controlled trials were screened out of 898 studies and 1593 patients were evaluated. The target blood pressure of the intervention group ranged from 50-90 mmHg in systolic pressure or mean arterial pressure ≥ 50 mmHg, while that of the control group was 65-110 mmHg systolic pressure or mean arterial pressure ≥ 60 mmHg. Only patients with penetrating injuries were evaluated in two studies, while the remaining six included blunt injuries. A statistically significant reduction in mortality was observed in the intervention group (RR = 0.70; 95%CI= 0.58-0.84; P < 0.05). Small heterogeneity was observed in the included articles (χ2 = 8.9; P = 0.18; I2 = 33%). The loss of platelet (PLT), hemoglobin (Hb) and body fluid was properly protected, the amount of resuscitation fluid was reduced, and the incidence of some adverse events was effectively reduced. There was no significant difference in coagulation time and hospital stay between the two groups.ConclusionsThis meta-analysis reveals the survival benefits of hypotension resuscitation in patients with traumatic hemorrhagic shock. The significant advantage is to promote the recovery of patients' physical function and reduce the incidence of treatment-related complications such as acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and multiple organ dysfunction syndrome (MODS), which reduces the mortality. Convincing evidences are provided based on these results, but larger, multicenter, randomized trials are needed to confirm the findings.

scholarly journals Moderately prolonged permissive hypotension results in reversible metabolic perturbation evaluated by intracerebral microdialysis - an experimental animal study

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Rasmus Peter Jakobsen ◽  
Troels Halfeld Nielsen ◽  
Simon Mølstrøm ◽  
Carl-Henrik Nordström ◽  
Asger Granfeldt ◽  
...  
Keyword(s):  
Energy Metabolism ◽  
Hemorrhagic Shock ◽  
Femoral Artery ◽  
Damage Control ◽  
Intracerebral Microdialysis ◽  
Permissive Hypotension ◽  
Cerebral Energy Metabolism ◽  
Sagittal Sinus ◽  
Metabolic Perturbation ◽  
Severe Hypotension

Abstract Background Damage control resuscitation (DCR) and damage control surgery (DCS) is the main strategy in patients with uncontrollable hemorrhagic shock. One aspect of DCR is permissive hypotension. However, the duration of hypotension that can be tolerated without affecting the brain is unknown. In the present study we investigate the effect of 60 min severe hypotension on the brain’s energy metabolism and seek to verify earlier findings that venous cerebral blood can be used as a marker of global cerebral energy state. Material and methods Ten pigs were anaesthetized, and vital parameters recorded. Microdialysis catheters were placed in the left parietal lobe, femoral artery, and superior sagittal sinus for analysis of lactate, pyruvate, glucose, glycerol, and glutamate. Hemorrhagic shock was induced by bleeding the animal until mean arterial pressure (MAP) of 40 mmHg was achieved. After 60 min the pigs were resuscitated with autologous blood and observed for 3 h. Results At baseline the lactate to pyruvate ratios (LP ratio) in the hemisphere, artery, and sagittal sinus were (median (interquartile range)) 13 (8–16), 21 (18–24), and 9 (6–22), respectively. After induction of hemorrhagic shock, the LP ratio from the left hemisphere in 9 pigs increased to levels indicating a reversible perturbation of cerebral energy metabolism 19 (12–30). The same pattern was seen in LP measurements from the femoral artery 28 (20–35) and sagittal sinus 22 (19–26). At the end of the experiment hemisphere, artery and sinus LP ratios were 16 (10–23), 17 (15–25), and 17 (10–27), respectively. Although hemisphere and sinus LP ratios decreased, they did not reach baseline levels (p < 0.05). In one pig hemisphere LP ratio increased to a level indicating irreversible metabolic perturbation (LP ratio > 200). Conclusion During 60 min of severe hypotension intracerebral microdialysis shows signs of perturbations of cerebral energy metabolism, and these changes trend towards baseline values after resuscitation. Sagittal sinus microdialysis values followed hemisphere values but were not distinguishable from systemic arterial values. Venous (jugular bulb) microdialysis might have a place in monitoring conditions where global cerebral ischemia is a risk.

scholarly journals Ideal Permissive Hypotension to Resuscitate Uncontrolled Hemorrhagic Shock and the Tolerance Time in Rats

2011 ◽  
Vol 114 (1) ◽  
pp. 111-119 ◽  
Author(s):  
Tao Li ◽  
Yu Zhu ◽  
Yi Hu ◽  
Lijie Li ◽  
Youfang Diao ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hemorrhagic Shock ◽  
Mitochondrial Function ◽  
Vital Organ ◽  
Organ Function ◽  
Total Blood ◽  
Permissive Hypotension ◽  
Animal Survival ◽  
Tolerance Time ◽  
The Ideal

Background Studies have shown that permissive hypotension for uncontrolled hemorrhagic shock can result in good resuscitation outcome. The ideal target mean arterial pressure (MAP) and the tolerance time for permissive hypotension have not been determined. Methods To elucidate the ideal target MAP and tolerance time for permissive hypotension with uncontrolled hemorrhagic shock rats, the effects of different target MAPs (40, 50, 60, 70, 80, and 100 mmHg) and 60-, 90-, and 120-min permissive hypotension (50 mmHg) on uncontrolled hemorrhagic shock were observed. Results Rats in normotensive groups (80 and 100 mmHg) had increased blood loss (101%, 126% of total blood volume), decreased hematocrit, decreased vital organ (liver and kidney) and mitochondrial function, and decreased animal survival rate (1 of 10). Rats in the 50- and 60-mmHg target MAP groups had decreased blood loss (52% and 69%, respectively), good hematocrit and vital organ and mitochondrial function, stable hemodynamics, and increased animal survival (8 of 10 and 6 of 10, respectively). Rats in the 40-mmHg target MAP group, although having decreased blood loss (39%), appeared to have very inferior organ function and animal survival (2 of 10). Animal survival (1 of 10) and vital organ function in the 120-min permissive hypotension group were significantly inferior to the 60- and 90-min groups. The 60- and 90-min groups had similar animal survival (8 of 10 and 6 of 10) and vital organ function. Conclusion A target resuscitation pressure of 50-60 mmHg is the ideal blood pressure for uncontrolled hemorrhagic shock. Ninety minutes of permissive hypotension is the tolerance limit; 120 min of hypotensive resuscitation can cause severe organ damage and should be avoided.

Treatment of ebola and other infectious diseases: melatonin “goes viral”

2020 ◽  
Vol 3 (1) ◽  
pp. 43-57 ◽  
Author(s):  
Russel J Reiter ◽  
Qiang Ma ◽  
Ramaswamy Sharma
Keyword(s):  
Mortality Rate ◽  
Infectious Diseases ◽  
Hemorrhagic Shock ◽  
Safety Profile ◽  
Ebola Virus ◽  
Viral Infections ◽  
Virus Disease ◽  
Attractive Potential ◽  
Potential Treatment

This review summarizes published reports on the utility of melatonin as a treatment for virus-mediated diseases. Of special note are the data related to the role of melatonin in influencing Ebola virus disease. This infection and deadly condition has no effective treatment and the published works documenting the ability of melatonin to attenuate the severity of viral infections generally and Ebola infection specifically are considered. The capacity of melatonin to prevent one of the major complications of an Ebola infection, i.e., the hemorrhagic shock syndrome, which often contributes to the high mortality rate, is noteworthy. Considering the high safety profile of melatonin, the fact that it is easily produced, inexpensive and can be self-administered makes it an attractive potential treatment for Ebola virus pathology.  

Hemorrhagic Shock and Encephalopathy Syndrome: A Case Report

2001 ◽  
Vol 44 (3) ◽  
pp. 385
Author(s):  
Sook Ja Yoon ◽  
Yun Sun Choi ◽  
Chung Ho Shin ◽  
Sung Bum Cho ◽  
Jae Min Cho ◽  
...  
Keyword(s):  
Case Report ◽  
Hemorrhagic Shock
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