Comprehensive Cancer Center in Bialystok, Poland.
Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland.
Cardiol J. 2022;29(3):463-471. doi: 10.5603/CJ.a2020.0096. Epub 2020 Jul 10.
Although the resuscitation of an adult trauma patient has been researched and written about for the past century, the ideal fluid strategy to infuse during the initial resuscitation period remains unresolved. This work was aimed at assessing the effect of hypotensive versus conventional resuscitation strategies in traumatic hemorrhagic shock patients on mortality, and the need for blood transfusions including adverse events.
This systematic review and meta-analysis were performed following the PRISMA guidelines. Electronic databases were searched for randomized controlled trials (RCT) comparing the effect of hypotension versus conventional fluid resuscitation for traumatic hemorrhagic shock patients. Two reviewers independently performed the screening, data extraction, and bias assessment. The data analysis was completed using the Cochrane Collaboration's software RevMan 5.4.
Data from 28 RCTs on 4503 patients were included in the final meta-analysis. Patients receiving hypotension fluid resuscitation compared with conventional fluid resuscitation experienced less mortality (12.5% vs. 21.4%; RR = 0.58; 95% CI: 0.51-0.66; p < 0.001), fewer adverse events (10.8% vs. 13.4%; RR = 0.70; 95% CI: 0.59-0.83; p < 0.001), including fever acute respiratory distress syndrome (7.8% vs. 16.8%) or multiple organ dysfunction syndrome (8.6% vs. 21.6%).
This meta-analysis showed that hypotensive fluid resuscitation significantly reduced the mortality of hypovolemic shock patients. Findings are low in certainty and should be interpreted with caution. Therefore, there is an urgent need for larger, multicenter, randomized trials to confirm these findings.
尽管过去一个世纪以来一直在研究和撰写成人创伤患者的复苏方法，但在初始复苏期间输注的理想液体策略仍未得到解决。这项工作旨在评估在创伤性失血性休克患者中低血压与常规复苏策略对死亡率的影响，以及包括不良事件在内的输血需求。
本系统评价和荟萃分析按照 PRISMA 指南进行。电子数据库检索了比较低血压与常规液体复苏对创伤性失血性休克患者影响的随机对照试验（RCT）。两名评审员独立进行了筛选、数据提取和偏倚评估。数据分析使用 Cochrane 协作的 RevMan 5.4 软件完成。
最终的荟萃分析纳入了 28 项 RCT 共 4503 名患者的数据。与常规液体复苏相比，接受低血压液体复苏的患者死亡率更低（12.5%比 21.4%；RR = 0.58；95%CI：0.51-0.66；p < 0.001），不良事件更少（10.8%比 13.4%；RR = 0.70；95%CI：0.59-0.83；p < 0.001），包括发热性急性呼吸窘迫综合征（7.8%比 16.8%）或多器官功能障碍综合征（8.6%比 21.6%）。
本荟萃分析表明，低血压液体复苏可显著降低低血容量休克患者的死亡率。研究结果的确定性较低，应谨慎解释。因此，迫切需要更大规模、多中心、随机试验来证实这些发现。
