title: Vasopressor use following traumatic injury: protocol for a systematic review.
abstract: Worldwide, traumatic casualties are projected to exceed 8 million by year 2020. Haemorrhagic shock and brain injury are the leading causes of death following trauma. While intravenous fluids have traditionally been used to support organ perfusion in the setting of haemorrhage, recent investigations have suggested that restricting fluid therapy by tolerating more severe hypotension may improve survival. However, the safety of permissive hypotension remains uncertain, particularly among patients who have suffered a traumatic brain injury. Vasopressors preferentially vasoconstrict blood vessels that supply non-vital organs and capacitance vessels, thereby mobilising the unstressed blood volume. Used as fluid-sparing adjuncts, these drugs can complement resuscitative measures by correcting hypotension without diluting clotting factors or increasing the risk for tissue oedema.
  
  
  
  We will identify randomised control trials comparing early resuscitation with vasopressors versus placebo or standard care in adults following traumatic injury. Data sources will include MEDLINE, EMBASE, CENTRAL, clinical trial registries and conference proceedings. Two reviewers will independently determine trial eligibility. For each included trial, we will conduct duplicate independent data extraction and risk of bias assessment. We will assess the overall quality of the data for each individual outcome using the GRADE approach.
  
  
  
  We will report this review in accordance with the PRISMA statement. We will disseminate our findings at critical care and trauma conferences and through a publication in a peer-reviewed journal. We will also use this systematic review to create clinical guidelines (http://www.magicapp.org), which will be disseminated in a standalone publication.
  
  
  
  CRD42016033437.
authors.affiliation: Department of Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Hylands
authors.affiliation: McMaster University, Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada.
authors.forename: Augustin
authors.initials: A
authors.lastname: Toma
authors.affiliation: Department of Anaesthesiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Beaudoin
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada.
authors.forename: Anne-Julie
authors.initials: AJ
authors.lastname: Frenette
authors.affiliation: Department of Anaesthesiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada.|Centre de recherche du CHU de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Frederick
authors.initials: F
authors.lastname: D'Aragon
authors.affiliation: McMaster University, Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada.|Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Emilie
authors.initials: E
authors.lastname: Belley-Côté
authors.affiliation: Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Hylander
authors.affiliation: Population Health and Optimal Health Practives Research Unit (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Lauzier
authors.affiliation: McMaster University, Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada.
authors.forename: Reed Alexander
authors.initials: RA
authors.lastname: Siemieniuk
authors.affiliation: Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Charbonney
authors.affiliation: Wuhan University, Center for Evidence-Based and Translational Medicine Zhongnan Hospital, Wuhan, China.
authors.forename: Joey
authors.initials: J
authors.lastname: Kwong
authors.affiliation: Oslo Universitetssykehus Ulleval, Oslo, Norway.
authors.forename: Jon Henrik
authors.initials: JH
authors.lastname: Laake
authors.affiliation: McMaster University, Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.affiliation: Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
authors.forename: Per Olav
authors.initials: PO
authors.lastname: Vandvik
authors.affiliation: McMaster University, Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada.
authors.forename: Bram
authors.initials: B
authors.lastname: Rochwerg
authors.affiliation: Department of Critical care, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Green
authors.affiliation: London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: Ball
authors.affiliation: Department of Critical Care, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Damon
authors.initials: D
authors.lastname: Scales
authors.affiliation: Department of Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Murthy
authors.affiliation: Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sandro
authors.initials: S
authors.lastname: Rizoli
authors.affiliation: Centre Hospitalier Universitaire d'Angers, Angers, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Asfar
authors.affiliation: Centre de recherche du CHU de Sherbrooke, Sherbrooke, Quebec, Canada.|Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: François
authors.initials: F
authors.lastname: Lamontagne
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D004837:Epinephrine / Q000627:therapeutic use*; D005440:Fluid Therapy; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012151:Resuscitation / Q000379:methods; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D000078202:Systematic Reviews as Topic; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine