title: Non-operative management of blunt liver injury: a new protocol for selected hemodynamically unstable patients under hypotensive resuscitation.
abstract: BACKGROUND
  The objective of this study was to evaluate our new protocol for performing non-operative management for selected unstable patients under hypotensive resuscitation using improved diagnostic imaging techniques.
  
  
  METHODS
  This retrospective study included 77 consecutive patients with blunt liver injury. They were divided into two groups: those treated before and those treated after the revision. Under the new protocol, we attempted to manage the patients non-operatively, usually with angioembolization, including those whose shock improved with fluid resuscitation and continuous loading, permitting the maintenance of a target systolic blood pressure of 80 mmHg. The outcomes of the two groups were evaluated and compared.
  
  
  RESULTS
  While comparing the groups, although there was no change in the liver-related morbidity and mortality rates, the urgent and overall laparotomy rates and transfusion requirements in 24 h significantly decreased after the protocol revision. While comparing the subgroups of high-grade injury (AAST Grades 3-5), the overall laparotomy rates and transfusion requirements in 24 h significantly decreased after the protocol revision.
  
  
  CONCLUSIONS
  All the selected unstable patients were successfully managed non-operatively after the protocol revision. The decrease in laparotomy rates and transfusion requirements confirmed the feasibility of our new protocol for these selected patients.
authors.affiliation: Department of Emergency Medicine, Tokyo Metropolitan Hiroo General Hospital, 2-11-1, Nerima-ku, Tokyo, 179-0072, Japan. makmitusada@v07.itscom.net.
authors.forename: Makoto
authors.initials: M
authors.lastname: Mitsusada
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Nakajima
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Shirokawa
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Takeda
authors.forename: Hideki
authors.initials: H
authors.lastname: Honda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002648:Child; D002985:Clinical Protocols; D004621:Embolization, Therapeutic / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics; D006801:Humans; D008099:Liver / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000628:therapy; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult
keywords: Angioembolization · Blunt liver injury · Hemodynamically unstable · Hypotensive resuscitation · Non-operative management