Reperfusion Injury After Hemorrhage: A Collective Review

G D. Rushing, MD; L D. Britt, MD, MPH

Disclosures

Annals of Surgery. 2008;247(6):929-937. 

In This Article

Timing of Treatment for Hemorrhagic Shock

In addition to ensuring a stable airway and adequate ventilation, the primary treatment goal in hemorrhagic shock is to address the bleeding. Frequently, this requires surgical intervention. Replacement of blood loss is necessary to continue oxygen delivery, but timing and extent of resuscitation are still investigational issues. Different resuscitation strategies are used to maintain blood pressure in trauma patients until bleeding is controlled. However, while maintaining blood pressure may prevent shock, it often worsens bleeding. Several studies have investigated early versus delayed resuscitation in the hypovolemic patient.[5,6,7,8,9,10,11,12,13] One of the largest randomized controlled trials by Turner et al showed no difference in mortality with early (10.4%) or delayed (9.8%) administration of fluids in 1309 trauma patients.[8] Another randomized controlled trial by Bickell, Mattox, and colleagues reported no differences in mortality and coagulation times on a total of 598 hypotensive trauma patients with penetrating torso injuries.[7] Many studies have tried to answer this question of early versus late use of fluids for resuscitation. Currently, the best data available demonstrate that there is no difference in mortality outcomes if surgical intervention is immediately available. However, the Advanced Trauma Life Support protocol of the American College of Surgeons recommends the liberal use of isotonic crystalloid to correct hypotension in bleeding trauma patients.[14]

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