The influence of hypotensive resuscitation in hemorrhagic shock with coexisting severe head injury: an experimental protocol

We examined the efficacy of hypotensive resuscitation, compared with fluid resuscitation, in patients with closed abdominal trauma and coexisting severe head injury.

Female pigs, 25–30 kg body weight, were used. Retrograde catheterization of the internal jugular vein (SjO₂) and laparotomy was performed. A surgical knot 4 mm long was made at the aorta, with a 3.0 diameter stitch. The abdomen was closed. Then a craniotomy and traumatic brain injury (TBI) was made. A regional cerebral blood flow catheter (RoCBF) was placed under the dura. After the TBI the intraabdominal hemorrhage was made by pulling the titch (rupture of the aorta). The animals were assigned into two groups: group A (fluid resuscitation) and group B (hypotensive resuscitation). The animals that survived after 1 hour of hemorrhage were managed by surgical checking and with 1 hour more of fluid resuscitation.

In group B there was complete restoration of cerebral blood flow and brain oxygenation, after the surgical checking of hemorrhage. Hypotensive resuscitation causes significant reduction in mortality in patients with closed intraabdominal trauma and coexisting head injury, without putting cerebral function in jeopardy.