Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries

William H. Bickell, Matthew J. Wall, Paul E. Pepe, R. Russell Martin, Victoria F. Ginger, Mary K. Allen, Kenneth L. Mattox

Research output: Contribution to journalArticle

1527 Citations (Scopus)

Abstract

Background. Fluid resuscitation may be detrimental when given before bleeding is controlled in patients with trauma. The purpose of this study was to determine the effects of delaying fluid resuscitation until the time of operative intervention in hypotensive patients with penetrating injuries to the torso. Methods. We conducted a prospective trial comparing immediate and delayed fluid resuscitation in 598 adults with penetrating torso injuries who presented with a prehospital systolic blood pressure ≤90 mm Hg. The study setting was a city with a single centralized system of prehospital emergency care and a single receiving facility for patients with major trauma. Patients assigned to the immediate-resuscitation group received standard fluid resuscitation before they reached the hospital and in the trauma center, and those assigned to the delayed-resuscitation group received intravenous cannulation but no fluid resuscitation until they reached the operating room. Results. Among the 289 patients who received delayed fluid resuscitation, 203 (70 percent) survived and were discharged from the hospital, as compared with 193 of the 309 patients (62 percent) who received immediate fluid resuscitation (P = 0.04). The mean estimated intraoperative blood loss was similar in the two groups. Among the 238 patients in the delayed- resuscitation group who survived to the postoperative period, 55 (23 percent) had one or more complications (adult respiratory distress syndrome, sepsis syndrome, acute renal failure, coagulopathy, wound infection, and pneumonia), as compared with 69 of the 227 patients (30 percent) in the immediate- resuscitation group (P = 0.08). The duration of hospitalization was shorter in the delayed-resuscitation group. Conclusions. For hypotensive patients with penetrating torso injuries, delay of aggressive fluid resuscitation until operative intervention improves the outcome.

Original languageEnglish (US)
Pages (from-to)1105-1109
Number of pages5
JournalNew England Journal of Medicine
Volume331
Issue number17
DOIs
StatePublished - Oct 27 1994

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Torso
Resuscitation
Wounds and Injuries
Blood Pressure
Systemic Inflammatory Response Syndrome
Trauma Centers
Adult Respiratory Distress Syndrome
Emergency Medical Services
Wound Infection
Operating Rooms
Operative Time
Acute Kidney Injury
Postoperative Period
Catheterization
Pneumonia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bickell, W. H., Wall, M. J., Pepe, P. E., Martin, R. R., Ginger, V. F., Allen, M. K., & Mattox, K. L. (1994). Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. New England Journal of Medicine, 331(17), 1105-1109. https://doi.org/10.1056/NEJM199410273311701

Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. / Bickell, William H.; Wall, Matthew J.; Pepe, Paul E.; Martin, R. Russell; Ginger, Victoria F.; Allen, Mary K.; Mattox, Kenneth L.

In: New England Journal of Medicine, Vol. 331, No. 17, 27.10.1994, p. 1105-1109.

Research output: Contribution to journalArticle

Bickell, WH, Wall, MJ, Pepe, PE, Martin, RR, Ginger, VF, Allen, MK & Mattox, KL 1994, 'Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries', New England Journal of Medicine, vol. 331, no. 17, pp. 1105-1109. https://doi.org/10.1056/NEJM199410273311701
Bickell, William H. ; Wall, Matthew J. ; Pepe, Paul E. ; Martin, R. Russell ; Ginger, Victoria F. ; Allen, Mary K. ; Mattox, Kenneth L. / Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. In: New England Journal of Medicine. 1994 ; Vol. 331, No. 17. pp. 1105-1109.
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