Traumatic Hypovolemia and Emergency Surgery: Comparing Liberal Fluid Resuscitation versus Restricted Fluid Resuscitation with Vasopressors Regarding Clinical and Laboratory Outcomes

Abstract

Background: Trauma is a leading cause of death world-wide, it is one of the major causes of hypovolemic shock, Con-cerns have been raised regarding the suitability of conventional aggressive crystalloid resuscitation methods in instances of traumatic hemorrhagic shock, as these methods are associat-ed with significant complications. Therefore, it is imperative to explore safer alternatives that may reduce the associated com-plications, morbidity, and mortality. Aim of Study: To investigate the efficacy of restricted fluid resuscitation with early vasopressors use in trauma and emer-gency surgeries and whether it decrease the mortality and com-plication in those patients. Patients and Methods: The study was conducted at Oper-ation Theater at Souad Kafafi University Hospital-Misr Uni-versity of science and Technology (MUST). 50 Patients aged 18-50 years, scheduled for urgent damage control surgeries, 25 patients in each group equally. Results: Resuscitation with restricted fluid volume along with early use of vasopressor resulted in a better control over the mean arterial pressure (MAP) mainly around 72.00 to 74.00 range than the conventional liberal fluid method, and a signif-icant concentration of central venous pressure values (CVP) around 7.3. In contrary to liberal method with a significant con-centration around 9.6. Restricted fluid with early vasopressors group throughout follow-up time points showed lower levels of serum lactate in-dicating better tissue perfusion and better pH state of the body, and a better recovery in the Troponin levels as well, there were statistically significant differences in troponin levels between the two groups at Time 4 and Time 5, as indicated by the p-val-ues (0.043 and 0.002, respectively). As for CRP levels measured post-operative, the F-tests for CRP levels at Times 4, 5, and 6 all indicate statistically signif-icant differences between the groups at each time point. The significance levels (all ≤0.001). Hemoglobin and Albumin levels post-operative, were sig-nificantly higher in the restricted fluid group in all time points compared to the liberal fluid group. Conclusion: The use of restricted fluid resuscitation with early use of vasopressors along with blood products has shown better outcome than the conventional liberal fluid method in resuscitation regarding the mortality and post-operative com-plications after damage control surgeries, based on a better control over blood pressure and avoiding volume overload with its risks like hemo-delusion or decrease in albumin levels, and better tissue perfusion markers indicating less chance of AKI or multi-organ failure or blood acidosis.