Article C136

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

Author(s): Stavros Gourgiotis, MD, PhD, George Gemenetzis, MD, Hemant Kocher, MD, FRCS, Stavros Aloizos, MD, Nikolaos Salemis, MD, PhD, Stylianos Grammenos, MD

Contact Hours 1.00

CERP A 1.00

Expires Dec 01, 2017

Topics: Cardiovascular, Trauma

Population: Adult

Role: Staff

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Activity Summary

Severity of hemorrhage and rate of bleeding are fundamental factors in the outcomes of trauma. Intravenous administration of fluid is the basic treatment to maintain blood pressure until bleeding is controlled. The main guideline, used almost worldwide, Advanced Trauma Life Support, established by the American College of Surgeons in 1976, calls for aggressive administration of intravenous fluids, primarily crystalloid solutions. Several other guidelines, such as Prehospital Trauma Life Support, Trauma Evaluation and Management, and Advanced Trauma Operative Management, are applied according to a patient’s current condition. However, the ideal strategy remains unclear. With permissive hypotension, also known as hypotensive resuscitation, fluid administration is less aggressive. The available models of permissive hypotension are based on hypotheses in hypovolemic physiology and restricted clinical trials in animals. Before these models can be used in patients, randomized, controlled clinical trials are necessary.

Objectives

  • State the purpose of permissive hypotension
  • Identify factors that affect fluid resuscitation
  • Discuss the physiologic response of permissive hypotension

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