Clarke Rebecca, Dippenaar Enrico
Anglia Ruskin University.
Anglia Ruskin University ORCID iD: https://orcid.org/0000-0001-8406-7373.
Br Paramed J. 2022 Dec 1;7(3):34-43. doi: 10.29045/14784726.2022.12.7.3.34.
Haemorrhage and subsequent hypovolemia from traumatic injury is a potentially reversible cause of cardiac arrest, as interventions can be made to increase circulatory volume and organ perfusion. Traditionally, intravenous (IV) fluid therapy is recommended for all patients who have experienced a haemorrhagic emergency. There has been some argument, however, that this may not be the most effective treatment as isotonic fluids can dilute coagulation factors and further stimulate bleeding. Permissive hypotension, also known as hypotensive resuscitation within the context of damage control resuscitation, is a method of managing haemorrhagic trauma patients by restricting IV fluid administration to allow for a reduced blood pressure. It is important to evaluate and compare current research literature on the effects of both permissive hypotension and fluid therapy on patients suffering from traumatic haemorrhage.
A rapid review was conducted by systematically searching and identifying literature to narratively compare permissive hypotension and fluid therapy. Searches were carried out across two databases to find relevant primary research containing quantitative data that provide contextual and statistical evidence to achieve the aim of this review. Papers were narratively synthesised to produce key themes for discussion.
The database searches identified 125 records, 78 from PubMed and 47 from ScienceDirect. Eleven duplicates were removed, and 114 titles screened. Ninety-four records were initially excluded and nine more after abstract review. Eleven papers were critiqued using Benton and Cormack's framework, with eight articles included in the final review.
Permissive hypotension may have a positive impact on 30-day mortality, when compared with fluid resuscitation methods, however there is evidence to suggest that hypotensive resuscitation may be more effective for blunt force injuries. Some studies even suggest a reduction in the treatment cost when reducing fluid volumes. Penetrating injuries are usually more likely to be a compressible source of haemorrhage within which haemorrhage control can be gained much more easily. There are recommendations for the use of permissive hypotension in both compressible and non-compressible injuries. It is difficult at this time to draw definitive conclusions for the treatment of every case related to traumatic haemorrhage given the variability and unpredictability of trauma.
创伤性损伤导致的出血及随后的低血容量是心脏骤停的一个潜在可逆原因，因为可以采取干预措施来增加循环血量和器官灌注。传统上，对于所有经历出血性紧急情况的患者，都推荐进行静脉输液治疗。然而，一直存在一些争议，认为这可能不是最有效的治疗方法，因为等渗液体会稀释凝血因子并进一步刺激出血。允许性低血压，即在损伤控制复苏背景下的低血压复苏，是一种通过限制静脉输液给药以降低血压来管理出血性创伤患者的方法。评估和比较当前关于允许性低血压和液体疗法对创伤性出血患者影响的研究文献很重要。
通过系统搜索和识别文献进行快速综述，以叙述方式比较允许性低血压和液体疗法。在两个数据库中进行搜索，以找到包含定量数据的相关原始研究，这些数据提供背景和统计证据以实现本综述的目的。对论文进行叙述性综合以产生讨论的关键主题。
数据库搜索识别出125条记录，其中78条来自PubMed，47条来自ScienceDirect。去除11条重复记录，筛选114个标题。最初排除94条记录，摘要审查后又排除9条。使用Benton和Cormack的框架对11篇论文进行了批判性评价，最终综述纳入8篇文章。
与液体复苏方法相比，允许性低血压可能对30天死亡率有积极影响，然而有证据表明低血压复苏对钝性暴力损伤可能更有效。一些研究甚至表明减少液体量时治疗成本会降低。穿透性损伤通常更可能是可压缩的出血源，在其中更容易实现出血控制。对于可压缩和不可压缩损伤，都有使用允许性低血压的建议。鉴于创伤的变异性和不可预测性，目前很难就每例创伤性出血相关病例的治疗得出明确结论。
