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Permissive hypotensive resuscitation in adult patients with traumatic haemorrhagic shock: A systematic review

Permissive hypotensive resuscitation in adult patients with traumatic haemorrhagic shock: A systematic review
Permissive hypotensive resuscitation in adult patients with traumatic haemorrhagic shock: A systematic review
Background:

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.

Methods:

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.

Results:

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).

Conclusions:

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.

Level of evidence:

Systematic review, level III.
Albreiki, Mohammed
c191f9a5-be08-4e18-999e-bc9eff905f02
Voegeli, David
e6f5d112-55b0-40c1-a6ad-8929a2d84a10
Albreiki, Mohammed
c191f9a5-be08-4e18-999e-bc9eff905f02
Voegeli, David
e6f5d112-55b0-40c1-a6ad-8929a2d84a10

Albreiki, Mohammed and Voegeli, David (2017) Permissive hypotensive resuscitation in adult patients with traumatic haemorrhagic shock: A systematic review. European Journal of Trauma and Emergency Surgery. (doi:10.1007/s00068-017-0862-y).

Record type: Article

Abstract

Background:

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.

Methods:

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.

Results:

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).

Conclusions:

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.

Level of evidence:

Systematic review, level III.

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More information

Accepted/In Press date: 9 October 2017
e-pub ahead of print date: 27 October 2017
Published date: 27 October 2017

Identifiers

Local EPrints ID: 415458
URI: http://eprints.soton.ac.uk/id/eprint/415458
PURE UUID: 6045ec87-462d-48c9-932f-24c8a6cddb35
ORCID for David Voegeli: ORCID iD orcid.org/0000-0003-3457-7177

Catalogue record

Date deposited: 10 Nov 2017 17:30
Last modified: 16 Dec 2019 18:39

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