Prospective evaluation of preoperative fluid resuscitation in hypotensive patients with penetrating truncal injury: A preliminary report

R. R. Martin, W. H. Bickell, P. E. Pepe, J. M. Burch, K. L. Mattox, J. Carrico, A. W. Fleming, J. Mendelson, M. Rohman, T. Kowalenko

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

Although intravenous (IV) fluid therapy is routinely prescribed for hypotensive injury victims, there are concerns that elevating the blood pressure before hemorrhage is controlled may be detrimental. This is a preliminary report of an ongoing randomized study designed to evaluate the effect fluid resuscitation, delayed until surgical intervention, has on the outcome for hypotensive victims of penetrating truncal injury. In the first year, 300 consecutive patients with gunshot or stab wounds to the trunk who had a systolic blood pressure of 90 mm Hg or less were entered into the study. Patients were excluded from the outcome analysis because of death at the scene or minor injury not requiring surgical intervention. The remaining study patients were randomized into (1) an immediate resuscitation group (n = 96) for whom IV fluid resuscitation was initiated in the ambulance and in the emergency center before surgical intervention, or (2) a delayed resuscitation group (n = 81) for whom IV fluid resuscitation was delayed until the time of surgical intervention. The two study groups were found to be well balanced with respect to anatomic injury severity, pretreatment vital signs, survival probability, and preoperative treatment times. There were no significant differences in the rate of survival to hospital discharge (immediate resuscitation group, 56%; delayed resuscitation group, 69%). There were no significant differences in the rate of postoperative complications. Further study is necessary to determine if it is advantageous to delay fluid resuscitation until surgical intervention.

Original languageEnglish (US)
Pages (from-to)354-362
Number of pages9
JournalJournal of Trauma
Volume33
Issue number3
StatePublished - 1992

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Resuscitation
Wounds and Injuries
Blood Pressure
Stab Wounds
Gunshot Wounds
Ambulances
Vital Signs
Fluid Therapy
Emergencies
Survival Rate
Hemorrhage
Survival

ASJC Scopus subject areas

  • Surgery

Cite this

Martin, R. R., Bickell, W. H., Pepe, P. E., Burch, J. M., Mattox, K. L., Carrico, J., ... Kowalenko, T. (1992). Prospective evaluation of preoperative fluid resuscitation in hypotensive patients with penetrating truncal injury: A preliminary report. Journal of Trauma, 33(3), 354-362.

Prospective evaluation of preoperative fluid resuscitation in hypotensive patients with penetrating truncal injury : A preliminary report. / Martin, R. R.; Bickell, W. H.; Pepe, P. E.; Burch, J. M.; Mattox, K. L.; Carrico, J.; Fleming, A. W.; Mendelson, J.; Rohman, M.; Kowalenko, T.

In: Journal of Trauma, Vol. 33, No. 3, 1992, p. 354-362.

Research output: Contribution to journalArticle

Martin, RR, Bickell, WH, Pepe, PE, Burch, JM, Mattox, KL, Carrico, J, Fleming, AW, Mendelson, J, Rohman, M & Kowalenko, T 1992, 'Prospective evaluation of preoperative fluid resuscitation in hypotensive patients with penetrating truncal injury: A preliminary report', Journal of Trauma, vol. 33, no. 3, pp. 354-362.
Martin, R. R. ; Bickell, W. H. ; Pepe, P. E. ; Burch, J. M. ; Mattox, K. L. ; Carrico, J. ; Fleming, A. W. ; Mendelson, J. ; Rohman, M. ; Kowalenko, T. / Prospective evaluation of preoperative fluid resuscitation in hypotensive patients with penetrating truncal injury : A preliminary report. In: Journal of Trauma. 1992 ; Vol. 33, No. 3. pp. 354-362.
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