IMMEDIATE VERSUS DELAYED FLUID RESUSCITATION FOR HYPOTENSIVE PATIENTSWITH PENETRATING TORSO INJURIES

Background. Fluid resuscitation may be detrimental when given before b leeding is controlled in patients with trauma. The purpose of this stu dy was to determine the effects of delaying fluid resuscitation until the time of operative intervention in hypotensive patients with penetr ating injuries to the torso. Methods. We conducted a prospective trial comparing immediate and delayed fluid resuscitation in 598 adults wit h penetrating torso injuries who presented with a pre; hospital systol ic blood pressure less than or equal to 90 mm Hg. The study setting wa s a city with a single centralized system of prehospital emergency car e and a single receiving facility for patients with major trauma. Pati ents assigned to the immediate-resuscitation group received standard f luid 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 dela yed fluid resuscitation, 203 (70 percent) survived and were discharged from the hospital, as compared with 193 of the 309 patients (62 perce nt) who received immediate fluid resuscitation (P = 0.04). The mean es timated intraoperative blood loss was similar in the two groups. Among the 238 patients in the delayed-resuscitation group who survived to t he postoperative period, 55 (23 percent) had. one or more complication s (adult respiratory distress syndrome, sepsis syndrome, acute renal f ailure, coagulopathy, wound infection, and pneumonia), as compared wit h 69 of the 227 patients (30 percent) in the immediate-resuscitation g roup (P = 0.08). The duration of hospitalization was shorter in the de layed-resuscitation group. Conclusions. For hypotensive patients with penetrating torso injuries, delay of aggressive fluid resuscitation un til operative intervention improves the outcome.