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Abstract Objectives Traumatic hemorrhagic shock is a major death-related factor contributing to mortality in emergencies and can be effectively handled by the Limited Fluid Resuscitation (LFR) method. In the current investigation, the authors analyzed the influence of different administrating blood pressure on the treatment outcomes of LFR. Methods 276 participants were enrolled in the current study retrospectively from January 2016 to December 2021 and were divided into three groups based on the administrating blood pressure of LFR. The difference among the three groups regarding serum levels of cytokines as well as blood hemodynamics parameters was analyzed. Results The results showed after the T2 stage treatment, cytokine levels in the three groups were all significantly influenced by different LFR strategies with medium MAP showing the strongest effects on the expression of all cytokine genes. Moreover, the MAP value was in positive correlation with IL-6, IL-10, and TNF-α levels, but showed no clear relation with IL-4 level in all three groups. Regarding the effects on hemodynamics parameters, the levels of CVP, CO, and CI were slightly increased by the different LFR administrating strategies, and the effect of medium and high MAP was statistically stronger than that of low MAP. Conclusion The present results showed that LFR would influence serum inflammatory levels by improving blood hemodynamics parameters. Medium MAP showed the strongest improving effects with the least side effects, which can be employed as the optimal administrating strategy for LFR in the future.
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PURPOSE@#It is a challenge for the primary hospitals to manage multiple trauma patients. In this article, we explored the advantage of establishing a surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in the early management of multiple trauma.@*METHODS@#This was a retrospective study and patients with multiple trauma in our hospital were collected and divided into two groups, based on time period and treat modes: group A (retrospective observation group) where patients were treated with the traditional treatment mode from January 2017 to December 2017 and group B (study group) where patients were treated in the SICU predominant by cardiothoracic surgeons from January 2018 to December 2018. Clinical data including demographics, injury severity score (ISS), causes of injury, time intervals from reception to entering SICU or operating room and mortality three days after injuries were collected. Data were analyzed by SPSS 20.0 software. Categorical variables were presented as number and/or frequency and continuous variables as mean ± SD.@*RESULTS@#Altogether 406 patients were included in this study, including 217 patients in group A and 189 patients in group B. General data between the two groups revealed no significant difference: mean age (years) (35.51 ± 12.97 vs. 33.62 ± 13.61, p = 0.631), gender distribution (mean/female, 130/87 vs. 116/73, p = 0.589) and ISS (15.92 ± 7.95 vs. 16.16 ± 6.89, p = 0.698). Fall from height were the dominant mechanism of injury, with 135 cases in group A (71.4%) and 121 cases in group B (55.8%), followed by traffic accidents. Injury mechanism showed no significant differences between two groups (p = 1.256). Introduction of the SICU significantly improved the care of trauma patients, regarding speed and mortality. Time intervals between reception and entering SICU or operating room was (108.23 ± 6.72) min and (45.67 ± 7.96) min in group A and B, respectively (p = 0.001). Mortality three days after injuries was 13.89% and 5.53% in group A and B, respectively (p = 0.005).@*CONCLUSION@#Establishing a SICU predominant by cardiothoracic surgeons can reduce the early mortality rates in multiple trauma patients.
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Objective To observe the effects of limited fluid resuscitation (LFR) on immune function and inflammatory mediators in patients with multiple bone fracturescomplicated with traumatic hemorrhagic shock. Methods One hundred and two patients with multiple bone fractures complicated with traumatic hemorrhagic shock admitted to the Affiliated Hospital of Medical College of Ningbo University from January 2014 to June 2016 were enrolled, and they were divided into a LFR group and a early sufficient routine fluid resuscitation (RFR) group by random number table, each group 51 cases. After admission, the patients in the two groups underwent bandaging and hemostasis at the traumatic sites and preoperative management was prepared. The patients in RFR group were treated with early sufficient RFR, while LFR group was treated with LFR. The changes of hematocrit (HCT), blood platelet count (PLT), prothrombin time (PT), blood lactic acid and immune cells, inflammatory mediators and micro RNA-155 (miR-155) were observed in patients of the two groups at 4 hours after resuscitation.Results Compared with RFR group, the resuscitation time (hours: 3.67±1.45 vs. 5.14±1.61), levels of PT (s: 11.43±2.21 vs. 15.73±2.52), serum lactic acid (mmol/L: 3.35±0.15 vs. 3.81±0.25), tumour necrosis factor-α [TNF-α (ng/L): 14.10±3.39 vs. 16.28±3.47], interleukin [IL-10 (ng/L): 31.43±10.51 vs. 40.09±13.23, IL-6 (ng/L): 490.10±55.13 vs. 610.30±63.15] and endothelin-1 [ET-1 (pg/L): 183.35±30.51 vs. 250.01±31.23] in LFR group were significantly decreased (allP < 0.01), while PLT (×109/L: 134.58±28.13 vs. 108.12±30.35), HCT (×10-2: 0.34±0.04 vs. 0.24±0.05), miR-155 (0.15±0.02 vs. 0.08±0.02) and CD4+CD25+ regulatory T cell [CD4+CD25+Treg (×10-2): 2.28±0.47 vs. 2.10±0.39] in LFR group were obviously increased (allP < 0.01).Conclusions Using LFR in the emergency treatment of patients with multiple bone fractures complicated with traumatic hemorrhagic shock can effectively shorten the resuscitation time, regulate the patients' coagulation function, reduce the unnecessary excessive liquid infusion, improve immune status and decrease the degree of inflammatory reaction.
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Objective To investigate the fluid resuscitation strategies to craniocerebral injury patients combined with multiple trauma.Methods This retrospective review was made on 124 patients with combined craniocerebal injury (GCS 3-12 points) plus multiple trauma.Based on the fluid resuscitation strategies,63 patients were treated with aggressive fluid resuscitation (AFR),and 61 with limited fluid resuscitation (LFR).A restrictive rehydration principle was performed with intensive hemodynamic monitoring:mean arterial pressure was kept between 70-80 mmHg for 48 hours and central venous pressure between 6-8 cmH2O for 48 hours in LFR group; mean arterial pressure was kept in basic level and central venous pressure between 8-12 cmH2O in AFR group.No significant differences were shown in the rest of treatments.Parameters were compared between groups such as blood pressure,shock index,coagulation function,imaging data,GCS,and GOS at 6 months postinjury.Results Between-group differences were insignificant with regard to mean arterial pressure (MAP),shock indices,ISS,trauma severity indices (TSI),and GCS (P ＞0.05).Blood pressure fluctuation in LFR group was (18.5 ±9.9) mmHg vs (29.4 ± 11.1) mmHg in AFR group (P ＜ 0.01).Eight patients developed intracranial hemorrhage progression in LFR group,with 3 being treated with craniotomy.In comparison,19 patients developed intracranial hemmorrhage progression in AFR group,with 10 being treated with craniotomy (P ＜ 0.01).Improvement in coagulation disorders was better in LFR group than in AFR group.On days 7 after admission,GCS in LFR groups was (9.1 ± 3.6) points vs (7.2 ± 2.3) points in AFR group (P ＜0.05).At 6-month follow-up,results were 34 good and 27 poor in LFR group,better than 23 good and 40 poor in AFR group.Conclusion For moderate to severe craniocerebral injury combined with multiple trauma,LFR is effective to treat coagulation disorders and hemorrhagic shock,reduce the probability of delayed intracranial hemorrhage,and further improve the outcome.
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Objective To compare the effects of limited fluid resuscitation and aggressive fluid resuscitation in treatment of uncontrolled hemorrhagic traumatic shock,and to improve the cure rate.Methods One hundred and twenty patients with hemorrhagic traumatic shock on the basis of outpatient registration number of single and double were divided into limited fluid resuscitation group(limited group,56 cases) and aggressive fluid resuscitation group (positive group,64 cases),respectively.The preoperative blood lactic acid,base excess,prothrombin time,hemoglobin was compared and the preoperative infusion and the number of patients with death was recorded.Results The preoperative infusion in limited group was significantly less than that in positive group [(1 050 ± 212) ml vs.(2 120 ± 186) ml],the difference was statistically significant (P ＜ 0.01).The mortality rate in limited group was significantly lower than that in positive group [12.50％(7/56) vs.28.12％(18/64)],the difference was statistically significant (P＜ 0.05).The preoperative blood lactic acid,base excess,prothrombin time in limited group were significantly lower than those in positive group [(3.31 ± 0.29) mmol/L vs.(5.78 ± 0.15) mmol/L,(5.42 ± 1.13) mmol/L vs.(9.86 ± 1.21) mmol/L,(11.7 ± 1.9) s vs.(18.1 ± 1.7) s],and the hemoglobin in limited group was significantly higher than that in positive group [(96 ± 18) g/L vs.(83 ± 20) g/L],the differences were statistically significant (P ＜0.01).Conclusions If hemorrhage is not controlled,early limited fluid resuscitation can maintain blood perfusion of vital organs,alleviate acidosis,reduce mortality and creat good conditions for advanced treatment.Limited fluid resuscitation is superior to aggressive fluid resuscitation in operative intervention for patients with uncomtrolled hemorrhagic traumatic shock.
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Objective To compare the effects of different resuscitation pressure on lung function of rats with uncontrolled hemorrhagic shock.Methods Uncontrolled hemorrhagic shock model of rats was built.Sixty Sprague-Dawley rats were randomly sent into six groups: NC group (the control group),NF group (shock but non-resuscitation),NS40,NS60 group (limited fluid resuscitation),NS80,NS100 group (large-volume fluid resuscitation).When the mean arterial pressure (MAP) reached between 35 mm Hg to 40 mm Hg (1 mm Hg=0.133kPa) resuscitation was begun,normal saline infusion was used to maintain the following desired endpoints.After the fluid resuscitation for one hour,rats of each fluid resuscitation group were given haemostasis and all-out fluid resuscitation,including blood infusion,to maintain the rats' MAP at 90 mm Hg.Results Findings showed that the blood loss in limited fluid resuscitation groups was significantly lower than that in large-volume fluid resuscitation groups at the situation of uncontrolled hemorrhagic shock,damage to lung tissue pathology and acidosis were significantly lower than those in large-volume fluid resuscitation groups.Nine rats in NS60 group survived 72 hours.Three rats in NS40 group survived 72 hours.No rat in NF group as well as in both NS80 and NS100 groups survived 72 hours.Conclusions Uncontrolled hem-orrhagic shock in trauma and different pressure of fluid resuscitation can cause lung injury to varying de-grees.Limited fluid resuscitation provide significant protective effects against such injuries.
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Objective To investigate the effects of resuscitation with limited fluid on rabbits with uncon-trolled hemordaagic shock. Method Uncontrolled hemorrhagic shock was produced in 40 rabbits. When the mean arterial pressure dropped to 40 manI-Ig and maintained for 30 minutes, resuscitation was initiated with Ringer solu-tion infusion into rabbits in large volume for group N3 (125 mL/kg) ,moderate volume for group N2 (92 mL/kg) and small amount for group N1 (57 mL/kg), and a drop of fluid was not given to rabbits of group N4. Besides, rob-bits of group N5 were controls without shock. MAP, fatality, volume of blood loss, SOD and Her were observed for 120 minutes or until death. Data were analyzed using SNK-q test and rank test. Results MAP, SOD and Het were higher, and fatality and blood loss were lower in group N5 than those in groups N1, N2,and N3 (P<0.01 ). MAP,fatality,blood loss and Het of group N4 were worse than those of groups N1,N2 and N3 (P<0.01). The blood loss and fatality in group N3 were significantly higher than those in groups N1 and N2 (P<0.01 ). SOD of kidney in group N3 was significantly lower than that in group N1 and N2(P<0.01). As the volume of fluid in-creased during resuscitation, Het of all animals was gradually becoming lower. As MAPS in groups N2, N3 and N4 were gradually becoming lower and lower, death increased. Conclusions Limited fluid resuscitation (57～92mL/kg) should be recommended to the therapeutic strategy for uncontrolled hemorrhagic shock.
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Objective: To compare the effects of traditional and limited resuscitation on mediators of inflammation and the lung injury in a rat model of hemorrhagic shock. Methods: Seventy-two male Spra-gue-Dawley rats were challenged with hemorrhage followed by unresuscitation or resuscitation with 6 mL/kg blood withdrawl and lactated Ringer's solution of 45 mL/(kg · h) ,30 mL/(kg · h) or 15 mL/ (kg · h). Rats were sacrificed at 24 hrs, 48 hrs and 72 hrs, respectively. Blood was withdrowed for testing plasma levels of lactic acid and TNF-α. Lungs were harvested for observation of the ratio of wet/dry weight and histology. Results: The unresuscitation group were dead within 2 ～ 12 hrs, while the resuscitation groups were survival. The MAP of group 15 mL/(kg · h) increased slowly, but the MAP of 30 and 45 mL/(kg · h) groups increased rapidly. The plasma levels of TNF-α at 24 and 72 hrs and the lactic acid at 24 hrs in group 45 mL/(kg · h) were higher than that of group 15 and 30 mL/(kg · h) (P < 0. 05). The ratio of W/D weight of lungs at 48 and 72 hrs in group 15 mL/(kg · h) was lower than that of group 45 and 30 mL/(kg · h)(P<0.05). The lung injury was alleviated in pace with the time elapsing. The lung injury was more severe in group 45 mL/(kg · h) than the other two groups in 24, 48 and 72 hrs(P <0. 05). Conclusion: Limited fluid resuscitation could decrease the plasma levels of TNF-α and lactic acid,and attenuate the lung injury.
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Objective To evaluate the effect of early limited fluid resuscitation in treatment of severe pelvic fracture accompanied with traumatic hemorrhagic shock. Methods A retrospective study was done on 96 patients with severe pelvic fractures accompanied with traumatic hemorrhagic shock admitted into hospital from January 2002 to December 2006. Of all, 55 patients ( routine resuscitation group)were dealt with routine fluid resuscitation and 41 (limited resuscitation group) with limited fluid resuscitation. The injury severity, degree of shock, start time of resuscitation, transfusion volume were statistically analyzed and compared in two groups. Results Routine resuscitation group received transfusion volume of (3 432 ± 1 156) ml, with cure rate of 64% and mortality rate of 36% ; while limited resuscitation group received transfusion volume of (2 685 ± 524) ml, with cure rate of 83% and mortality rate of 17%. There was statistical difference between both groups ( P ＜ 0.05 ). Conclusion Limited fluid resuscitation can improve cure rate of severe pelvic fracture accompanied with traumatic hemorrhagic shock.
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Objective To compare the clinical effect and safety of limited fluid resuscitation and aggressive/normotensive fluid resuscitation in treatment of earthquake-induced traumatic hemorrhagic shock patients so as to provide reference for clinical application.Methods A total of 62 patients with traumatic hemorrhagic shock in earthquake were employed and divided randomly into limited fluid resuscitation group(Group Ⅰ,30 patients)and aggressive/normotensive fluid resuscitation group(Group Ⅱ,32 patients).All the patients were resuscitated by using halanted solution and HAES-steril as resuscitanaid resuscitation.Then,surgical hemostasis was carried out and dynamic changes of mean blood pressure(MAP),heart rate and central venous pressure(CVP)observed.The base excess,lactic acid and creatinine were detected at four resuscitation points.Results Before full fluid resuscitation,MAP remained at 50-70 mm Hg and 70-90 mm Hg respectively in both groups.After early resuscitation.heart rate showed significant decrease,while CVP increased(P＜0.01)but still changed at normal range.Total transfusion volume in Group Ⅰ was less than that of GroupⅡ(P＜0.01).There was no statistical difference upon urine volume(P＞0.05).There was statistical difierence upon base excess value after resuscitation within group(P＜0.01)but no statistical difference between two groups(P＞0.05).After resuscitation,hetic acid level wag obviously reduced in both groups(P＜0.01),with more significant change in Group Ⅰ,with statistical difference compared with Group Ⅱ(P＜0.01).There showed a significant decrease of creatinine in both groups after resuscitation.with statistical difierence within group (P＜0.01)but without statistical difference between two groups(P＞0.05).Conclusions Compared with aggressive/normotensive fluid resuscitation,limited fluid resuscitation is a more safe and effective way for fluid resuscitation of traumatic hemorrhagic shock,for it can not only reduce transfusion volume and ameliorate hemodynamic indices,but also can increase oxygen supply,improve microcirculation and protect renal function.
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Objective To evaluate the effect of limited fluid resuscitation treatments on the hemorrhagic traumatic shock in order to improve the cure rate. Methods Forty cases of the hemorrhagic traumatic shock patient were randomly divided into the regular fluid resuscitation group (n=21, regular group) and the limited fluid resuscitation group (n=19, limited group). In regular group, fast infusion of the full quantity fluid underwent in the early stage before hemostasia, keeping systolic blood pressure ≥ 90 mm Hg 1mm Hg=0.133 kPa. In limited group, infusion of fluid was limited before hemostasia, keeping average MAP at 6.65 kPa, then blood transfuse and fluid infusion underwent after hemostasia. After hemostasia, two groups kept MAP at 9.31～10.64 kPa. Results Three cases died in regular group, and the cure rate was 85.7%. No death in limit group, and the cure rate was 100%. There was significance difference between two groups (P
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New conception of first-aid in battlefield stress that medical service should be with wound soldiers. Moreover the primary principle is save and rescue lives. The traditional drugs and methods of resuscitation are approved and re-evaluated on their effect evidence based on clinical practice, such as the comparison between vasopressin and epinephrine on the effect of resuscitation, the elimination of lidocaine from preventive use in acute myocardial infarction, and the confirmation of amiodarone as the initial drug for the arrhythmic patients with heart failure and for the patients of cardiac arrest failed to be resuscitated with defibrillation and epinephrine. The traditional treatment of quick fluid replacement for hemorrhagic shock has been reassessed with the concept of limited fluid resuscitation. The application should be further evaluated of crystalloid, colloid or hypertonic saline in critical and trauma patients.