CHAPTER 90 PERMISSIVE HYPOTENSION IN TRAUMA

Immediate vs. Delayed Fluid Resuscitation for Hypotensive Patients with Penetrating Torso Injuries

Bickell WH, Wall MJ Jr, Pepe PE, et al. NEJM. 1994;331(17):1105–1109

BACKGROUND

Aggressive isotonic fluid administration was a standard in trauma resuscitation for many years; however, increasing evidence in the early 1990s suggested a restrictive strategy might be beneficial. It was postulated that aggressive administration of fluids can disrupt thrombus formation and increase bleeding. This study was an early attempt to compare a delayed vs. standard approach in trauma patients and assess for mortality benefit.

OBJECTIVES

To determine whether hypotensive penetrating trauma patients who have fluid resuscitation delayed until the time of operative intervention have improved survival compared to patient receiving standard fluid resuscitation.

METHODS

Prospective trial with even–odd day assignments to two treatment arms in a Houston area EMS system and primary trauma hospital between 1989 and 1992.

Participants

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