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Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis

BACKGROUND: Damage control strategies play an important role in trauma patient management. One such strategy, hypotensive resuscitation, is being increasingly employed. Although several randomized controlled trials have reported its benefits, the mortality benefit of hypotensive resuscitation has no...

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Autores principales: Owattanapanich, Natthida, Chittawatanarat, Kaweesak, Benyakorn, Thoetphum, Sirikun, Jatuporn
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296142/
https://www.ncbi.nlm.nih.gov/pubmed/30558650
http://dx.doi.org/10.1186/s13049-018-0572-4
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author Owattanapanich, Natthida
Chittawatanarat, Kaweesak
Benyakorn, Thoetphum
Sirikun, Jatuporn
author_facet Owattanapanich, Natthida
Chittawatanarat, Kaweesak
Benyakorn, Thoetphum
Sirikun, Jatuporn
author_sort Owattanapanich, Natthida
collection PubMed
description BACKGROUND: Damage control strategies play an important role in trauma patient management. One such strategy, hypotensive resuscitation, is being increasingly employed. Although several randomized controlled trials have reported its benefits, the mortality benefit of hypotensive resuscitation has not yet been systematically reviewed. OBJECTIVES: To conduct a meta-analysis of the efficacy of hypotensive resuscitation in traumatic hemorrhagic shock patients relative to mortality as the primary outcome, with acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and multiple organ dysfunction as the secondary outcomes. METHODS: PubMed, Medline-Ovid, Scopus, Science Direct, EMBASE, and CNKI database searches were conducted. An additional search of relevant primary literature and review articles was also performed. Randomized controlled trials and cohort studies reporting the mortality rate associated with hypotensive resuscitation or limited fluid resuscitation were selected. The random-effects model was used to estimate mortality and onset of other complications. RESULTS: Of 2114 studies, 30 were selected for this meta-analysis. A statistically significant decrease in mortality was observed in the hypotensive resuscitation group (risk ratio [RR]: 0.50; 95% confidence interval [CI]: 0.40–0.61). Heterogeneity was observed in the included literature (I(2): 27%; degrees of freedom: 23; p = 0.11). Less usage of packed red cell transfusions and fluid resuscitations was also demonstrated. No significant difference between groups was observed for AKI; however, a protective effect was observed relative to both multiple organ dysfunction and ARDS. CONCLUSIONS: This meta-analysis revealed significant benefits of hypotensive resuscitation relative to mortality in traumatic hemorrhagic shock patients. It not only reduced the need for blood transfusions and the incidences of ARDS and multiple organ dysfunction, but it caused a non-significant AKI incidence.
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spelling pubmed-62961422018-12-18 Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis Owattanapanich, Natthida Chittawatanarat, Kaweesak Benyakorn, Thoetphum Sirikun, Jatuporn Scand J Trauma Resusc Emerg Med Original Research BACKGROUND: Damage control strategies play an important role in trauma patient management. One such strategy, hypotensive resuscitation, is being increasingly employed. Although several randomized controlled trials have reported its benefits, the mortality benefit of hypotensive resuscitation has not yet been systematically reviewed. OBJECTIVES: To conduct a meta-analysis of the efficacy of hypotensive resuscitation in traumatic hemorrhagic shock patients relative to mortality as the primary outcome, with acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and multiple organ dysfunction as the secondary outcomes. METHODS: PubMed, Medline-Ovid, Scopus, Science Direct, EMBASE, and CNKI database searches were conducted. An additional search of relevant primary literature and review articles was also performed. Randomized controlled trials and cohort studies reporting the mortality rate associated with hypotensive resuscitation or limited fluid resuscitation were selected. The random-effects model was used to estimate mortality and onset of other complications. RESULTS: Of 2114 studies, 30 were selected for this meta-analysis. A statistically significant decrease in mortality was observed in the hypotensive resuscitation group (risk ratio [RR]: 0.50; 95% confidence interval [CI]: 0.40–0.61). Heterogeneity was observed in the included literature (I(2): 27%; degrees of freedom: 23; p = 0.11). Less usage of packed red cell transfusions and fluid resuscitations was also demonstrated. No significant difference between groups was observed for AKI; however, a protective effect was observed relative to both multiple organ dysfunction and ARDS. CONCLUSIONS: This meta-analysis revealed significant benefits of hypotensive resuscitation relative to mortality in traumatic hemorrhagic shock patients. It not only reduced the need for blood transfusions and the incidences of ARDS and multiple organ dysfunction, but it caused a non-significant AKI incidence. BioMed Central 2018-12-17 /pmc/articles/PMC6296142/ /pubmed/30558650 http://dx.doi.org/10.1186/s13049-018-0572-4 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Original Research
Owattanapanich, Natthida
Chittawatanarat, Kaweesak
Benyakorn, Thoetphum
Sirikun, Jatuporn
Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis
title Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis
title_full Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis
title_fullStr Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis
title_full_unstemmed Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis
title_short Risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis
title_sort risks and benefits of hypotensive resuscitation in patients with traumatic hemorrhagic shock: a meta-analysis
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296142/
https://www.ncbi.nlm.nih.gov/pubmed/30558650
http://dx.doi.org/10.1186/s13049-018-0572-4
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