title: Permissive Hypotension: Potentially Harmful in the Elderly? A National Trauma Data Bank Analysis.
abstract: Permissive hypotension is a component of damage control resuscitation that aims to provide a directed, controlled resuscitation, while countering the "lethal triad." This principle has not been specifically studied in elderly (ELD) trauma patients (≥55 years). Given the ELD population's lack of physiologic reserve and risk of inadequate perfusion with "normal" blood pressures, we hypothesized that utilized a permissive hypotension strategy in ELD trauma patients would result in worse outcomes compared with younger patients (18-54 years). A retrospective review of National Trauma Data Bank reports from 2009 and 2010, identifying critically ill patients undergoing a "damage control laparotomy," was performed to determine the effect of age and systolic blood pressure on outcome. Logistic regression analysis, including evaluation of an interaction between age and admission blood pressure, was performed on mortality using admission demographics, physiology, injury severity, mechanism of injury, and in-hospital complications. Although there was a higher likelihood of death with greater age, lower admission systolic blood pressure, lower Glasgow Coma Score, increased injury severity score, and acute renal failure, a synergistic effect of age and blood pressure on mortality was not identified. Permissive hypotension appears to be a possible management strategy in ELD trauma patients.
authors.affiliation: Department of Surgery, The Brody School of Medicine at East Carolina University, Vidant Medical Center, Greenville, North Carolina, USA.
authors.forename: Lindsay C
authors.initials: LC
authors.lastname: Bridges
authors.forename: Brett H
authors.initials: BH
authors.lastname: Waibel
authors.forename: Mark A
authors.initials: MA
authors.lastname: Newell
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001795:Blood Pressure Determination; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality*; D016208:Databases, Factual; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*