title: Target blood pressure for hypotensive resuscitation.
abstract: BACKGROUND
  Good outcomes have resulted from hypotensive resuscitation of hemorrhagic shock patients. We hypothesized that mean arterial pressure (MAP) 60mmHg is the target blood pressure for hypotensive resuscitation during uncontrolled hemorrhagic shock in trauma.
  
  
  METHODS
  To determine the effective target MAP for hypotensive resuscitation during uncontrolled hemorrhagic shock, we randomly assigned 80 rats to one of 8 treatment groups (n=10 for each group). We then observed the effects of different target MAPs (control, 40, 50, 60, 70, 80, 90mmHg, and sham) on fluid resuscitation of uncontrolled hemorrhagic shock. Blood pressure, serum lactate, hematocrit, fluid therapy, blood loss, and plasma cytokine levels were measured at 0, 30, 90, 120, 180, 240, 300min after the start of the surgical procedure.
  
  
  RESULTS
  A target MAP of 90, 80 and 70mmHg had increased blood loss and decreased hematocrit and IL-6 and TNF-α production. A target MAP of 60, 50 and 40mmHg had lower blood loss, good hematocrit, higher IL-6 and TNF-α production, and decreased animal survival. Only target MAPs of 40 and 50 had and decreased animal survival. The differences in blood loss, hematocrit, lactate, post-resuscitation MAP, survival, IL-6, IL-10, and TNF-α production between rats with a target MAP of 60mmHg and those with a target MAP of 70mmHg were not significant. The amount of fluid therapy in the BP 60 groups was less than in the BP 70 groups (P<0.001).
  
  
  CONCLUSIONS
  A MAP of 60mmHg should be considered for evaluation in human studies as a target for hypotensive resuscitation.
authors.affiliation: Department of Emergency Medicine, National Taiwan University, College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Geng-Shiau
authors.initials: GS
authors.lastname: Lin
authors.forename: Tzung-Hsin
authors.initials: TH
authors.lastname: Chou
authors.forename: Cheng-Yi
authors.initials: CY
authors.lastname: Wu
authors.forename: Meng-Che
authors.initials: MC
authors.lastname: Wu
authors.forename: Cheng-Chung
authors.initials: CC
authors.lastname: Fang
authors.forename: Zui-Shen
authors.initials: ZS
authors.lastname: Yen
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Lee
authors.forename: Shyr-Chyr
authors.initials: SC
authors.lastname: Chen
mesh_terms: D000818:Animals; D016207:Cytokines / Q000378:metabolism; D004195:Disease Models, Animal; D005440:Fluid Therapy / Q000379:methods; D006400:Hematocrit; D007022:Hypotension; D007552:Isotonic Solutions / Q000494:pharmacology*; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D051381:Rats; D017208:Rats, Wistar; D012039:Regional Blood Flow; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000473:pathology / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
chemical_list: D016207:Cytokines; D007552:Isotonic Solutions; D014409:Tumor Necrosis Factor-alpha; D019344:Lactic Acid
keywords: Animal model; Hypotensive resuscitation; Mean arterial pressure; Uncontrolled hemorrhagic shock