Albreiki Mohammed, Voegeli David
Faculty of Health Science, University of Southampton, Southampton, SO17 1BJ, UK.
Sultan Qaboos University Hospital, Muscat, Oman.
Eur J Trauma Emerg Surg. 2018 Apr;44(2):191-202. doi: 10.1007/s00068-017-0862-y. Epub 2017 Oct 27.
Permissive hypotensive resuscitation (PHR) is an advancing concept aiming towards deliberative balanced resuscitation whilst treating severely injured patients, and its effectiveness on the survival rate remains unexplored. This detailed systematic review aims to critically evaluate the available literature that investigates the effects of PHR on survival rate.
A systematic review design searched for comparative and non-comparative studies using EMBASE, MEDLINE, PubMed, Web-of-Science and CENTRAL. Full-text articles on adult trauma patients with low blood pressure were considered for inclusion. The risk of bias and a critical appraisal of the identified articles were performed to assess the quality of the selected studies. Included studies were sorted into comparative and non-comparative studies to ease the process of analysis. Mortality rates of PHR were calculated for both groups of studies.
From the 869 articles that were initially identified, ten studies were selected for review, including randomised control trials (RCTs) and cohort studies. By applying the risk of bias assessment and critique tools, the methodologies of the selected articles ranged from moderate to high quality. The mortality rates among patients resuscitated with low volume and large volume in the selected RCTs were 21.5% (123/570) and 28.6% (168/587) respectively, whilst the total mortality rate of the patients enrolled in three non-comparative studies was 9.97% (279/2797).
The death rate amongst post-trauma patients managed with conservative resuscitation was lower than standard aggressive resuscitation, which indicates that PHR can create better survival rate among traumatised patients. Therefore, PHR is a feasible and safely practiced fluid resuscitative strategy to manage haemorrhagic shock in pre-hospital and in-hospital settings. Further trials on PHR are required to assess its effectiveness on the survival rate.
Systematic review, level III.
允许性低血压复苏（PHR）是一种不断发展的概念，旨在对重伤患者进行审慎的平衡复苏，但其对生存率的有效性仍未得到探索。本详细的系统评价旨在严格评估调查PHR对生存率影响的现有文献。
采用系统评价设计，通过EMBASE、MEDLINE、PubMed、科学网和Cochrane中心对照试验注册库检索比较性和非比较性研究。纳入关于低血压成年创伤患者的全文文章。对纳入文章进行偏倚风险评估和严格评价，以评估所选研究的质量。将纳入研究分为比较性和非比较性研究，以简化分析过程。计算两组研究中PHR的死亡率。
从最初识别的869篇文章中，选择了10项研究进行综述，包括随机对照试验（RCT）和队列研究。通过应用偏倚风险评估和评价工具，所选文章的方法学质量从中等到高质量不等。在所选RCT中，小容量复苏和大容量复苏患者的死亡率分别为21.5%（123/570）和28.6%（168/587），而三项非比较性研究中患者的总死亡率为9.97%（279/2797）。
采用保守复苏治疗的创伤后患者死亡率低于标准积极复苏，这表明PHR可提高创伤患者的生存率。因此，PHR是一种可行且安全的液体复苏策略，可用于院前和院内失血性休克的治疗。需要进一步开展关于PHR的试验，以评估其对生存率的有效性。
系统评价，III级。
