Abstract
Abstract Background: Traumatic shock is a condition that is notoriously difficult to treat, especially as it often affects many organ systems with “competing interests”, and renders the body on the edge of what its physiology can handle. Results from studies on ever more realistic animal models in the late 1980´s renewed an old way of thinking about traumatic shock – keep the pressure low until the surgeon has control of the bleeding. Objective: The aim of this thesis is to do a review of the evidence base for the methods of restrictive fluid therapy or permissive hypotension in the hypotensive trauma patient. Methods: We did a systematic search in the literature for clinical trials on the subject of fluid therapy for hypotensive trauma patients (excluding blood products and studies that compare different fluids) through PubMed and Cochrane Libraries, and considered four prospective studies suitable for our search. The four studies all had an intervention group that was given fluids initially after major trauma in either a restrictive way when it comes to volume preoperatively, or followed a lower target blood pressure until bleeding was stopped. Results: One study claimed a survival benefit in the intervention group, the three others did not. We concluded that there is not strong enough evidence to prefer the restrictive or hypotensive model in favour of the standard liberal fluid method. Conclusion: Given that the results from the prospective clinical trials are unclear, and since the two different philosophies appear similar in safety for the patient, it is up to the discretion of local guideline makers, how to treat this patient group. The impression of the authors is that the restrictive or permissive hypotension philosophy is the standard of care amongst most health care providers.