Permissive Hypotension for Trauma Patients with Hemorrhagic Shock

In 1994, a large trial (N Engl J Med 1994; 331:17) demonstrated decreased mortality with delayed crystalloid resuscitation in hypotensive patients with penetrating trauma, compared with more-aggressive resuscitation. Subsequent trials have been underpowered, but a recent systematic review of five randomized studies (J Trauma Acute Care Surg 2018; 84:802) reported decreased mortality (odds ratio 0.7) with permissive hypotension compared with targeting higher blood pressures (typically 90 mm Hg systolic).

A new systematic review of trauma patients with hemorrhagic shock included a search of the China National Knowledge Infrastructure, identifying 19 Chinese studies (15 randomized, 4 observational) in addition to the 5 previously identified tri…