Prospective evaluation of preoperative fluid resuscitation in hypotensive patients with penetrating truncal injury: a preliminary report.
Although intravenous (IV) fluid therapy is routinely prescribed for hypotensive injury victims, there are concerns that elevating the blood pressure before hemorrhage is controlled may be detrimental. This is a preliminary report of an ongoing randomized study designed to evaluate the effect fluid resuscitation, delayed until surgical intervention, has on the outcome for hypotensive victims of penetrating truncal injury. In the first year, 300 consecutive patients with gunshot or stab wounds to the trunk who had a systolic blood pressure of 90 mm Hg or less were entered into the study. Patients were excluded from the outcome analysis because of death at the scene or minor injury not requiring surgical intervention. The remaining study patients were randomized into (1) an immediate resuscitation group (n = 96) for whom IV fluid resuscitation was initiated in the ambulance and in the emergency center before surgical intervention, or (2) a delayed resuscitation group (n = 81) for whom IV fluid resuscitation was delayed until the time of surgical intervention. The two study groups were found to be well balanced with respect to anatomic injury severity, pretreatment vital signs, survival probability, and preoperative treatment times. There were no significant differences in the rate of survival to hospital discharge (immediate resuscitation group, 56%; delayed resuscitation group, 69%). There were no significant differences in the rate of postoperative complications. Further study is necessary to determine if it is advantageous to delay fluid resuscitation until surgical intervention.
Martin
R R
RR
Cora & Webb Mading Department of Surgery, Baylor College of Medicine, Houston, Texas 77030.
Bickell
W H
WH
Pepe
P E
PE
Burch
J M
JM
Mattox
K L
KL
D000007:Abdominal Injuries / Q000150:complications* / Q000401:mortality / Q000601:surgery; D000328:Adult; D001803:Blood Transfusion / Q000592:standards; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D006769:Hospitals, General; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015994:Incidence; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011300:Preoperative Care / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D011446:Prospective Studies; D012151:Resuscitation / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D013898:Thoracic Injuries / Q000150:complications* / Q000401:mortality / Q000601:surgery; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000150:complications* / Q000401:mortality / Q000601:surgery