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

Kamil Safiejko, Jacek Smereka, Krzysztof J. Filipiak, Agnieszka Szarpak, Marek Dabrowski, Jerzy R. Ladny, Milosz J. Jaguszewski, Lukasz Szarpak
DOI: 10.5603/CJ.a2020.0096
·
Pubmed: 32648249

open access

Ahead of print
Original articles
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.

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Keywords

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

Supplementary 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.
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Supplementary Figure S2. Summary of the risk of bias among the included studies.
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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
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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
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Supplementary table 1
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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

Ahead of print

Article type

Research paper

Published online

2020-07-10

DOI

10.5603/CJ.a2020.0096

Pubmed

32648249

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

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