title: Hypotensive resuscitation in a head-injured multi-trauma patient.
abstract: The concept of permissive hypotension is a controversial topic in trauma care. While driving blood pressure to "normal" levels with large volume crystalloid infusions is not appropriate, definitive data on the target blood pressure for hypotensive resuscitation are lacking. Indeed, the concept of systolic blood pressure as a marker for resuscitation is arguable. In this case presentation, a panel of experts in trauma resuscitation discusses the merits and limitations of hypotensive resuscitation in the context of a patient who has sustained multiple injuries, including a head injury. The controversies highlighted herein call attention to the role of the intensivist in managing a continuing resuscitation while coordinating the care of other physicians whose therapies can run at cross-purposes to one another. The challenges of the practice of critical care in the 21st century are no more apparent than in the care of a complex trauma patient.
authors.affiliation: David Geffen School of Medicine at UCLA, Department of Anesthesiology/Division of Critical Care, Los Angeles, CA 90095-7403, USA. Electronic address: jmtobin@mednet.ucla.edu.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Tobin
authors.affiliation: Clinical Associate, Anesthesia Quality Institute, American Society of Anesthesiologists, Department of Anesthesia & Critical Care, University of Chicago, Chicago, IL, USA. Electronic address: r.dutton@asahq.org.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Dutton
authors.affiliation: Director of the Division of Critical Care Anesthesiology, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: pittetj@uab.edu.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Pittet
authors.affiliation: Chief of the Division of Neuroanesthesiology and Perioperative Neurosciences, University of Washington, Seattle, WA, USA. Electronic address: dsharma@uw.edu.
authors.forename: Deepak
authors.initials: D
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D001803:Blood Transfusion; D006259:Craniocerebral Trauma / Q000628:therapy; D000077324:Crystalloid Solutions; D004638:Emergency Treatment / Q000379:methods* / Q000592:standards; D015600:Glasgow Coma Scale; D006801:Humans; D007022:Hypotension / Q000503:physiopathology / Q000628:therapy*; D007442:Intubation, Intratracheal; D007552:Isotonic Solutions / Q000008:administration & dosage; D022125:Lacerations / Q000150:complications; D008099:Liver / Q000293:injuries; D008297:Male; D009104:Multiple Trauma / Q000628:therapy*; D012151:Resuscitation / Q000379:methods*; D013610:Tachycardia / Q000503:physiopathology
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions
keywords: Hypotension; Resuscitation; Trauma Care; Traumatic Brain Injury