Cargando…

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

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Safiejko, Kamil, Smereka, Jacek, Filipiak, Krzysztof J., Szarpak, Agnieszka, Dabrowski, Marek, Ladny, Jerzy R., Jaguszewski, Milosz J., Szarpak, Lukasz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Via Medica 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9170316/
https://www.ncbi.nlm.nih.gov/pubmed/32648249
http://dx.doi.org/10.5603/CJ.a2020.0096
_version_ 1784721395620511744
author Safiejko, Kamil
Smereka, Jacek
Filipiak, Krzysztof J.
Szarpak, Agnieszka
Dabrowski, Marek
Ladny, Jerzy R.
Jaguszewski, Milosz J.
Szarpak, Lukasz
author_facet Safiejko, Kamil
Smereka, Jacek
Filipiak, Krzysztof J.
Szarpak, Agnieszka
Dabrowski, Marek
Ladny, Jerzy R.
Jaguszewski, Milosz J.
Szarpak, Lukasz
author_sort Safiejko, Kamil
collection PubMed
description 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.
format Online
Article
Text
id pubmed-9170316
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Via Medica
record_format MEDLINE/PubMed
spelling pubmed-91703162022-06-07 Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: A systematic review and meta-analysis of randomized controlled trials Safiejko, Kamil Smereka, Jacek Filipiak, Krzysztof J. Szarpak, Agnieszka Dabrowski, Marek Ladny, Jerzy R. Jaguszewski, Milosz J. Szarpak, Lukasz Cardiol J Clinical Cardiology 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. Via Medica 2022-05-31 /pmc/articles/PMC9170316/ /pubmed/32648249 http://dx.doi.org/10.5603/CJ.a2020.0096 Text en Copyright © 2022 Via Medica https://creativecommons.org/licenses/by-nc-nd/4.0/This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially
spellingShingle Clinical Cardiology
Safiejko, Kamil
Smereka, Jacek
Filipiak, Krzysztof J.
Szarpak, Agnieszka
Dabrowski, Marek
Ladny, Jerzy R.
Jaguszewski, Milosz J.
Szarpak, Lukasz
Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: A systematic review and meta-analysis of randomized controlled trials
title Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: A systematic review and meta-analysis of randomized controlled trials
title_full Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: A systematic review and meta-analysis of randomized controlled trials
title_fullStr Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: A systematic review and meta-analysis of randomized controlled trials
title_full_unstemmed Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: A systematic review and meta-analysis of randomized controlled trials
title_short Effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: A systematic review and meta-analysis of randomized controlled trials
title_sort effectiveness and safety of hypotension fluid resuscitation in traumatic hemorrhagic shock: a systematic review and meta-analysis of randomized controlled trials
topic Clinical Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9170316/
https://www.ncbi.nlm.nih.gov/pubmed/32648249
http://dx.doi.org/10.5603/CJ.a2020.0096
work_keys_str_mv AT safiejkokamil effectivenessandsafetyofhypotensionfluidresuscitationintraumatichemorrhagicshockasystematicreviewandmetaanalysisofrandomizedcontrolledtrials
AT smerekajacek effectivenessandsafetyofhypotensionfluidresuscitationintraumatichemorrhagicshockasystematicreviewandmetaanalysisofrandomizedcontrolledtrials
AT filipiakkrzysztofj effectivenessandsafetyofhypotensionfluidresuscitationintraumatichemorrhagicshockasystematicreviewandmetaanalysisofrandomizedcontrolledtrials
AT szarpakagnieszka effectivenessandsafetyofhypotensionfluidresuscitationintraumatichemorrhagicshockasystematicreviewandmetaanalysisofrandomizedcontrolledtrials
AT dabrowskimarek effectivenessandsafetyofhypotensionfluidresuscitationintraumatichemorrhagicshockasystematicreviewandmetaanalysisofrandomizedcontrolledtrials
AT ladnyjerzyr effectivenessandsafetyofhypotensionfluidresuscitationintraumatichemorrhagicshockasystematicreviewandmetaanalysisofrandomizedcontrolledtrials
AT jaguszewskimiloszj effectivenessandsafetyofhypotensionfluidresuscitationintraumatichemorrhagicshockasystematicreviewandmetaanalysisofrandomizedcontrolledtrials
AT szarpaklukasz effectivenessandsafetyofhypotensionfluidresuscitationintraumatichemorrhagicshockasystematicreviewandmetaanalysisofrandomizedcontrolledtrials