Optimal fluid resuscitation for patients with presumed uncontrolled internal haemorrhage: The rationale of permissive hypotension till surgical haemostasis

Background: Few clinical human studies applied the permissive hypotensive regimen as strategy in uncontrolled hemorrhage by limited fluid resuscitation till surgical control of bleeding. So, early aggressive fluid resuscitation will be proposed in this study in the face of permissive hypotension by slow fluid regimen to differentiate the clinical superiority of either regimen in uncontrolled hemorrhage. Methods: This prospective, randomized study included 40 adult patients aged (20-40years), of either sex diagnosed as uncontrolled abdominal bleeding. Patients were randomly allocated into two groups. Each group included 20 patients: 1-GroupA (aggressive resuscitation regimen), where aggressive Ringer acetate infusion were given in a trial to achieve a mean arterial blood pressure above 80 mmHg as end point before control of bleeding, 2- GroupP (permissive hypotensive regimen), where Ringer acetate infusion were given in a trial to achieve mean arterial blood pressure (MAP) above 50 mmHg as end point before control of bleeding. The same anesthetic regimen was applied for both groups. Results: The results of this study showed shift of values of HR, MAP, CVP, and urine output toward a clinically accepted values with both regimens of fluid management. There were no significant differences as regard to liver, and kidney functions in both groups within the study time. Also, this study demonstrated that group (A) had a statistically higher INR, and APTT values at intraoperative and immediate postoperative time as compared to group (P). Also, group (A) showed a statistically significant decrease in PaO2, and SaO2 as compared to group (P) at the immediate postoperative time. The incidence of complications such as ARDS, pneumonia, need of ventilation, also was higher in group (A) than group (P). Conclusion: This study concluded that permissive hypotension before control of surgical bleeding was superior to aggressive resuscitation as regard to coagulation profile, oxygenation, and incidence of complications.