emDocs - August 20, 2014 - By Brett Sweeney
"Included below is a summary of numerous blog posts and podcasts that discuss the sometimes controversial issue of permissive hypotension or minimum volume resuscitation in the bleeding trauma patient.
The Basics
- Idea of keeping BP low in traumatic hemorrhage to avoid “popping the clot”
- Based mostly on data from animal trials and penetrating trauma in humans
- Common practice in most major trauma centers in USA
- The exact approach still remains controversial around the world
Disclaimer: These are highlights as interpreted by the author of this article and should not replace listening to the original podcast or reviewing the background research. Posts are in chronological order and many of the below podcasts go beyond the scope of permissive hypotension....
Overall conclusions
- Permissive hypotension is a small part of the larger Damage Control Resuscitation
- A target MAP is unclear but 55-65 seems to be the general consensus
- BP is a poor measure of perfusion
- Not every MAP of 65 is equal – quality of perfusion is just as important as the MAP
- While human evidence for permissive hypotension is lacking – it is common practice in trauma centers
Questions/Controversies
- Is permissive hypotension applicable to all types of trauma or just penetrating?
- What is the best way to gauge perfusion – can we throw away BP cuffs?
- Should resuscitation strategies differ in patients with head injury?
- Is there any role at all for crystalloids in the trauma resuscitation?
http://www.emdocs.net/foamed-roadmap-permissive-hypotension/