Restricted fluid resuscitation improves the prognosis of patients with traumatic hemorrhagic shock

Objective: To explore the effect of restricted fluid resuscitation on coagulation, the serum inflammatory factors, and the prognoses of patients with traumatic hemorrhagic shock. Methods: This prospective randomized controlled trial recruited 160 patients with traumatic hemorrhagic shock from the Department of Emergency in Ningbo No. 6 Hospital. The patients were randomly divided into two groups: the patients in one group received restricted fluid resuscitation (the experimental group, n=80) and the patients in the other group received routine fluid resuscitation (the control group, n=80). The differences in the infusion volumes and mean arterial pressure (MAP) levels during the resuscitation as well as the levels of the serum inflammatory factors (TNF-α, IL-4, IL-6, IL-10) and the coagulation function indexes (platelet (PLT), prothrombin time (PT), activated partial thromboplastin time (APPT)) before and after resuscitation were compared between the two groups. The mortality and the incidences of acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) of the patients in both groups during their hospital stays were calculated. Results: During the fluid resuscitation, the infusion volume in the experimental group was significantly lower than it was in the control group (P<0.001). After the resuscitation, the experimental group had significantly lower MAP and serum TNF-α, IL-4, IL-6 and IL-10 levels, but significantly higher plasma lactic acid, hemoglobin (Hb), hematocrit (Hct) and base excess (BE) as well as PLT, PT, and APTT levels than the control group. The mortality (6.3% vs 16.3%, P=0.045) and the incidences of ARDS (12.5% vs 27.5%, P=0.018) and MODS (8.8% vs 22.5%, P=0.017) in the experimental group were significantly lower than they were in the control group. Conclusion: Restricted fluid resuscitation can significantly improve the serum inflammatory factor levels, the coagulation indicators, and the prognoses of patients with traumatic hemorrhagic shock and can reduce their infusion volumes and MAP levels.

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