Target blood pressure for hypotensive resuscitation.

Abstract

BACKGROUND:

Good outcomes have resulted from hypotensive resuscitation of hemorrhagic shock patients. We hypothesized that mean arterial pressure (MAP) 60mmHg is the target blood pressure for hypotensive resuscitation during uncontrolled hemorrhagic shock in trauma.

METHODS:

To determine the effective target MAP for hypotensive resuscitation during uncontrolled hemorrhagic shock, we randomly assigned 80 rats to one of 8 treatment groups (n=10 for each group). We then observed the effects of different target MAPs (control, 40, 50, 60, 70, 80, 90mmHg, and sham) on fluid resuscitation of uncontrolled hemorrhagic shock. Blood pressure, serum lactate, hematocrit, fluid therapy, blood loss, and plasma cytokine levels were measured at 0, 30, 90, 120, 180, 240, 300min after the start of the surgical procedure.

RESULTS:

A target MAP of 90, 80 and 70mmHg had increased blood loss and decreased hematocrit and IL-6 and TNF-α production. A target MAP of 60, 50 and 40mmHg had lower blood loss, good hematocrit, higher IL-6 and TNF-α production, and decreased animal survival. Only target MAPs of 40 and 50 had and decreased animal survival. The differences in blood loss, hematocrit, lactate, post-resuscitation MAP, survival, IL-6, IL-10, and TNF-α production between rats with a target MAP of 60mmHg and those with a target MAP of 70mmHg were not significant. The amount of fluid therapy in the BP 60 groups was less than in the BP 70 groups (P<0.001).

CONCLUSION:

A MAP of 60mmHg should be considered for evaluation in human studies as a target for hypotensive resuscitation.

• Authors: Geng-Shiau Lin, Tzung-Hsin Chou, Cheng-Yi Wu, Meng-Che Wu, Cheng-Chung Fang, Zui-Shen Yen, Chien-Chang Lee, Shyr-Chyr Chen
• Journal: Injury (Injury) Vol. 44 Issue 12 Pg. 1811-5 (Dec 2013) ISSN: 1879-0267 [Electronic] Netherlands
• PMID: 23490320 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 Elsevier Ltd. All rights reserved.

Chemical References

• Cytokines
• Isotonic Solutions
• Tumor Necrosis Factor-alpha
• Lactic Acid

Topics

• Animals
• Cytokines (metabolism)
• Disease Models, Animal
• Fluid Therapy (methods)
• Hematocrit
• Hypotension
• Isotonic Solutions (pharmacology)
• Lactic Acid (metabolism)
• Male
• Rats
• Rats, Wistar
• Regional Blood Flow
• Resuscitation (methods)
• Shock, Hemorrhagic (pathology, therapy)
• Tumor Necrosis Factor-alpha (metabolism)