Multimedialna platforma wiedzy medycznej Internetowa Księgarnia Medyczna Kalendarium Konferencji
Cardiology Journal
MENU
Shortcuts Submit an article CJ Guide for Authors (new) Recent articles Special collections Ahead Of Print APIS-S Online Calculator OCT Contrast Calculator Reviewers 2022

open access

Vol 29, No 3 (2022)
Original Article
Submitted: 2020-06-25
Accepted: 2020-07-06
Published online: 2020-07-10
View PDF Download PDF file View HTML Supp./Additional Files [5]
Get Citation

Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: A systematic review and meta-analysis of randomized controlled trials

Kamil Safiejko1, Jacek Smereka23, Krzysztof J. Filipiak4, Agnieszka Szarpak5, Marek Dabrowski6, Jerzy R. Ladny37, Milosz J. Jaguszewski8, Lukasz Szarpak39
DOI: 10.5603/CJ.a2020.0096
·
Pubmed: 32648249
·
Cardiol J 2022;29(3):463-471.
Affiliations
  1. Comprehensive Cancer Center in Bialystok, Poland
  2. Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
  3. Polish Society of Disaster Medicine, Warsaw, Poland
  4. First Chair and Department of Cardiology, Medical University of Warsaw, Poland
  5. Maria Skłodowska-Curie Medical Academy in Warsaw, Poland
  6. Chair and Department of Medical Education, Poznan University of Medical Sciences, Poznan, Poland
  7. Clinic of Emergency Medicine, Medical University of Bialystok, Poland
  8. First Department of Cardiology, Medical University of Gdansk, Poland
  9. Bialystok Oncology Center, Bialystok, Poland

open access

Vol 29, No 3 (2022)
Original articles — Clinical cardiology
Submitted: 2020-06-25
Accepted: 2020-07-06
Published online: 2020-07-10

Abstract

Background: 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.
Methods: 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.
Results: 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%).
Conclusions: 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.

Abstract

Background: 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.
Methods: 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.
Results: 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%).
Conclusions: 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.

Full Text:

View PDF Download PDF file View HTML Supp./Additional Files [5]
Get Citation

Keywords

fluid resuscitation, restricted fluid resuscitation, hemorrhagic shock, hemorrhage, meta-analysis, systematic review

Supp./Additional Files (5)
Supplementary Figure S1. Evaluation of bias in all included studies across the various domains. Green, red, and yellow circles indicate low, high, and unclear risk of bias, respectively.
View
1MB
Supplementary Figure S2. Summary of the risk of bias among the included studies.
View
6MB
Supplementary Figure S3. Forest plot of hypotension versus. conventional fluid resuscitation, relative to the length of stay in the Intensive Care Unit. The centre of each square represents the mean difference for individual trials, and the corresponding
View
7MB
Supplementary Figure S4. Forest plot of hypotension versus. conventional fluid resuscitation, relative to the length of stay in hospital. The centre of each square represents the mean difference for individual trials, and the corresponding horizontal line
View
7MB
Supplementary Table 1
Download
64KB
About this article
Title

Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: A systematic review and meta-analysis of randomized controlled trials

Journal

Cardiology Journal

Issue

Vol 29, No 3 (2022)

Article type

Original Article

Pages

463-471

Published online

2020-07-10

Page views

7844

Article views/downloads

2832

DOI

10.5603/CJ.a2020.0096

Pubmed

32648249

Bibliographic record

Cardiol J 2022;29(3):463-471.

Keywords

fluid resuscitation
restricted fluid resuscitation
hemorrhagic shock
hemorrhage
meta-analysis
systematic review

Authors

Kamil Safiejko
Jacek Smereka
Krzysztof J. Filipiak
Agnieszka Szarpak
Marek Dabrowski
Jerzy R. Ladny
Milosz J. Jaguszewski
Lukasz Szarpak

References (51)
  1. Alberdi F, García I, Atutxa L, et al. Trauma and Neurointensive Care Work Group of the SEMICYUC. Epidemiology of severe trauma. Med Intensiva. 2014; 38(9): 580–588.
    CrossRefPubMed
  2. Alexandrescu R, O'Brien SJ, Lecky FE. A review of injury epidemiology in the UK and Europe: some methodological considerations in constructing rates. BMC Public Health. 2009; 9: 226–231.
    CrossRefPubMed
  3. Krzych ŁJ, Czempik PF. Effect of fluid resuscitation with balanced solutions on platelets: In vitro simulation of 20% volume substitution. Cardiol J. 2018; 25(2): 254–259.
    CrossRefPubMed
  4. Baskett T. William O'Shaughnessy, Thomas Latta and the origins of intravenous saline. Resuscitation. 2002; 55(3): 231–234.
    CrossRefPubMed
  5. Milano R. Fluid resuscitation of the adult trauma patient: where have we been and where are we going? Nurs Clin North Am. 2017; 52(2): 237–247.
    CrossRefPubMed
  6. Kalkwarf KJ, Cotton BA. Resuscitation for hypovolemic shock. Surg Clin North Am. 2017; 97(6): 1307–1321.
    CrossRefPubMed
  7. Beaty CA, George TJ, Conte JV. Historical perspectives of The American Association for Thoracic Surgery: Alfred Blalock (1899-1964). J Thorac Cardiovasc Surg. 2012; 143(2): 260–263.
    CrossRefPubMed
  8. Ravitch MM. The contributions of Alfred Blalock to the science and practice of surgery. Johns Hopkins Med J. 1977; 140(2): 57–67.
    PubMed
  9. Srivastava A. Fluid resuscitation: principles of therapy and. Adv Chronic Kidney Dis. 2017; 24(4): 205–212.
    CrossRefPubMed
  10. Solomonov E, Hirsh M, Yahiya A, et al. The effect of vigorous fluid resuscitation in uncontrolled hemorrhagic shock after massive splenic injury. Crit Care Med. 2000; 28(3): 749–754.
    CrossRefPubMed
  11. Varela JE, Cohn SM, Diaz I, et al. Splanchnic perfusion during delayed, hypotensive, or aggressive fluid resuscitation from uncontrolled hemorrhage. Shock. 2003; 20(5): 476–480.
    CrossRefPubMed
  12. Muttath A, Annayappa Venkatesh L, Jose J, et al. Adverse outcomes due to aggressive fluid resuscitation in children: a prospective observational study. J Pediatr Intensive Care. 2019; 8(2): 64–70.
    CrossRefPubMed
  13. Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions. Version 5.1 [updated March 2011]. The Cochrane Collaboration. http://handbook-5-1.cochrane.org/ (Accessed 10 June 2020).
  14. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5: 13.
    CrossRefPubMed
  15. Higgins JPT, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003; 327(7414): 557–560.
    CrossRefPubMed
  16. Bickell WH, Wall MJ, Pepe PE, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994; 331(17): 1105–1109.
    CrossRefPubMed
  17. Carrick MM, Morrison CA, Tapia NM, et al. Intraoperative hypotensive resuscitation for patients undergoing laparotomy or thoracotomy for trauma: Early termination of a randomized prospective clinical trial. J Trauma Acute Care Surg. 2016; 80(6): 886–896.
    CrossRefPubMed
  18. Chen M, Zhong W, Hu Y. The study on limited fluid resuscitation patients with traumatic shock. Sichuan Med J. 2013; 34: 1–10.
  19. Chen M. Analysis on the efficacy of limited fluid resuscitation of traumatic hemorrhagic shock. China Academic J. 2015; 22: 3–6.
  20. Chen I, Bin L, Ai-guo Z, et al. The application of limited fluid resuscitation in first aid of hemorrhagic traumatic shock. J Hunan Normal Univ. 2015; 12: 1–5.
  21. Dai Y. Effect of limited fluid resuscitation on prognosis of patients with severe closed traumatic hemorrhagic shock. J Liaoning Medical University. 2016; 37: 1–5.
  22. Dutton RP, Mackenzie CF, Scalea TM. Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. J Trauma. 2002; 52(6): 1141–1146.
    CrossRefPubMed
  23. Fun H, Yue M, Wu Y, et al. Early therapeutic effects of limited fluid resuscitation on severe pelvic fracture combined with hemorrhagic shock. J Traumatic Surg. 2011; 13(5): 1–4.
  24. Fan H, Wu Y, Yue M. Early therapeutic effects of limited fluid resuscitation on severe hepatic and spleen injury combined with hemorrhagic shock. J Trauma Surg. 2012; 14: 10–16.
  25. Hua LD, Tu YY, Fu JF, et al. Application of limited fluid resuscitation in patients with severe multiple trauma hemorrhagic shock. Progress in Modern Biomedicine. 2010; 10(13): 2462–2464.
  26. Li W, Lin H, Deng X. Clinical discussion of limited fluid resuscitation on hemorrhagic traumatic shock without controlling bleeding. J Clini Med Engineering. 2012; 19: 1–9.
  27. Lu Bo, Li MQ, Li JQ. The use of limited fluid resuscitation and blood pressure-controlling drugs in the treatment of acute upper gastrointestinal hemorrhage concomitant with hemorrhagic shock. Cell Biochem Biophys. 2015; 72(2): 461–463.
    CrossRefPubMed
  28. Morrison CA, Carrick MM, Norman MA, et al. Hypotensive resuscitation strategy reduces transfusion requirements and severe postoperative coagulopathy in trauma patients with hemorrhagic shock: preliminary results of a randomized controlled trial. J Trauma. 2011; 70(3): 652–663.
    CrossRefPubMed
  29. Schreiber MA, Meier EN, Tisherman SA, et al. A controlled resuscitation strategy is feasible and safe in hypotensive trauma patients: results of a prospective randomized pilot trial. J Trauma Acute Care Surg. 2015; 78(4): 687–95; discussion 695.
    CrossRefPubMed
  30. Huang T, Zhang Y. Analysis of the therapeutic effect of limited fluid resuscitation in hemorrhagic shock patients. China Modern Doctor. 2015; 53: 11–15.
  31. Tang T, Li WP. The curative effect analysis of limited fluid resuscitation to esophageal variceal bleeding combined with hemorrhagic shock. Modern Practical Medicine. 2013; 25: 3–8.
  32. Turner J, Nicholl J, Webber I, et al. A randomised controlled trial of prehospital intravenous fluid replacement therapy in serious trauma. Health Technology Assessment. 2000; 4(31).
    CrossRef
  33. Wang A, Gao J, Li X, et al. The significance of APACHE II and IL-6 in patients with traumatic hemorrhagic shock by limited fluids resuscitation. Tianjin Med J. 2010; 38(11): 1–6.
  34. Wang Mt, Mei b, He J, et al. Effect of preoperative limited fluid resuscitation to the patients with traumatic shock. J Medi Coll of PLA. 2007; 22(4): 226–229.
    CrossRef
  35. Wang X, L Z, Wei L. Diagnosis and treatment of traumatic hemorrhagic shock caused by rupture of the liver and spleen on early fluid resuscitation. J Hepatobiliary Surg. 2014; 22: 4–7.
  36. Wang F. Efficacy of limited fluid resuscitation in the early treatment of patients with active hemorrhagic shock. Henan Med Res. 2016; 25: 3–9.
  37. Wei SK, He Y, Huang YQ, et al. Clinical analysis of 56 hemorrhagic patients with limited fluid resuscitation. J Youjiang National Med Coll. 2008; 1(2): 9.
  38. Wen Z, Liu J, Chen J. Comparison of application effects by hypertonic saline fluid resuscitation, limited fluid resuscitation and conventional fluid resuscitation in traumatic hemorrhagic shock. China Prac Med. 2015; 10: 15–18.
  39. Xu G. Clinical observation on limited fluid resuscitation in the treatment of uncontrolled hemorrhagic shock. Chinese J Disaster Med. 2015; 3: 5–9.
  40. Yao J, Lu JA. comparative study on the clinical effect of limited fluid resuscitation and active fluid resuscitation in the treatment of patients with multiple trauma and hemorrhagic shock. Chinese J Frontier Med. 2015; 7: 6–10.
  41. Zeng F, Deng Z, Hu M, et al. Clinical observation of limited fluid resuscitation on preoperative uncontrolled hemorrhagic shock. J Chin Pract Diagn Ther. 2014; 28: 1–5.
  42. Zhao Y. The clinical effect analysis of limited fluids resuscitation in treatment of hemorrhagic shock. Medical Innovation of China. 2013; 10: 36–40.
  43. Zheng W, Wang X, Xu H. Effects of limited fluid resuscitation in treatment of hemorrhagic traumatic shock. China J Emergency Resuscitation Disaster Med. 2007; 2: 9.
  44. de Crescenzo C, Gorouhi F, Salcedo ES, et al. Prehospital hypertonic fluid resuscitation for trauma patients: A systematic review and meta-analysis. J Trauma Acute Care Surg. 2017; 82(5): 956–962.
    CrossRefPubMed
  45. Martin GS, Bassett P. Crystalloids vs. colloids for fluid resuscitation in the Intensive Care Unit: A systematic review and meta-analysis. J Crit Care. 2019; 50: 144–154.
    CrossRefPubMed
  46. Malbrain ML, Marik PE, Witters I, et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther. 2014; 46(5): 361–380.
    CrossRefPubMed
  47. Hjortrup PB, Haase N, Bundgaard H, et al. Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial. Intensive Care Med. 2016; 42(11): 1695–1705.
    CrossRefPubMed
  48. Zafrani L, Mariotte E, Darmon M, et al. Acute renal failure is prevalent in patients with thrombotic thrombocytopenic purpura associated with low plasma ADAMTS13 activity. J Thrombosis Haemostasis. 2015; 13(3): 380–389.
    CrossRef
  49. In JiW, Kim JE, Jeong JS, et al. Diagnostic and prognostic significance of neutrophil gelatinase-associated lipocalin in disseminated intravascular coagulation. Clin Chim Acta. 2014; 430: 145–149.
    CrossRefPubMed
  50. Levi M, van der Poll T. Disseminated intravascular coagulation: a review for the internist. Intern Emerg Med. 2013; 8(1): 23–32.
    CrossRefPubMed
  51. Jiang LM, He J, Xi XY, et al. Effect of early restrictive fluid resuscitation on inflammatory and immune factors in patients with severe pelvic fracture. Chin J Traumatol. 2019; 22(6): 311–315.
    CrossRefPubMed

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl