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Volume 331:1105-1109 October 27, 1994 Number 17 Next

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ABSTRACT

Background Fluid resuscitation may be detrimental when given before bleeding is controlled in patients with trauma. The purpose of this study was to determine the effects of delaying fluid resuscitation until the time of operative intervention in hypotensive patients with penetrating injuries to the torso.

Methods We conducted a prospective trial comparing immediate and delayed fluid resuscitation in 598 adults with penetrating torso injuries who presented with a prehospital systolic blood pressure 90 mm Hg. The study setting was a city with a single centralized system of prehospital emergency care and a single receiving facility for patients with major trauma. Patients assigned to the immediate-resuscitation group received standard fluid 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 delayed fluid resuscitation, 203 (70 percent) survived and were discharged from the hospital, as compared with 193 of the 309 patients (62 percent) who received immediate fluid resuscitation (P = 0.04). The mean estimated intraoperative blood loss was similar in the two groups. Among the 238 patients in the delayed-resuscitation group who survived to the postoperative period, 55 (23 percent) had one or more complications (adult respiratory distress syndrome, sepsis syndrome, acute renal failure, coagulopathy, wound infection, and pneumonia), as compared with 69 of the 227 patients (30 percent) in the immediate-resuscitation group (P = 0.08). The duration of hospitalization was shorter in the delayed-resuscitation group.

Conclusions For hypotensive patients with penetrating torso injuries, delay of aggressive fluid resuscitation until operative intervention improves the outcome.

Source Information

From the Department of Emergency Services, Saint Francis Hospital, Tulsa, Okla. (W.H.B.); the Cora and Webb Mading Department of Surgery (M.J.W., P.E.P., M.K.A., K.L.M.) and the Department of Medicine (P.E.P.), Baylor College of Medicine, Houston; Ben Taub General Hospital, Houston (M.J.W., P.E.P., K.L.M.); the City of Houston Emergency Medical Services, Houston (P.E.P., V.F.G.); and the Department of Surgery, Section of Trauma, Brooke Army Medical Center, Fort Sam Houston, Tex. (R.R.M.).

Address reprint requests to Dr. Mattox at Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030.

Full Text of this Article

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Immediate versus Delayed Fluid Resuscitation in Patients with Trauma
Siegel J. H., Veech R. L., Lessard M. R., Brochu J. G., Brisson J., Carli P. A., de la Coussaye J. E., Riou B., Bickell W. H., Pepe P. E., Mattox K. L.
Extract | Full Text  
N Engl J Med 1995; 332:681-683, Mar 9, 1995. Correspondence

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