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Permissive strategies in intensive care units (ICUs): actual trends?
Anesth Pain Med (Seoul)
January 2025
Department of Surgery, Faculty of Medicine, University of Medicine, Tirana, Albania.
Permissive strategies in the intensive care unit (PSICU) intentionally allow certain physiological parameters to deviate from traditionally strict control limits to mitigate the risks associated with overly aggressive interventions. These strategies have emerged in response to evidence that rigid adherence to normal physiological ranges may cause harm to critically ill patients, leading to iatrogenic complications or exacerbation of underlying conditions. This review discusses several permissive strategies, including those related to hypotension, hypercapnia, hypoxemia, and lower urinary output thresholds.
View Article and Find Full Text PDFUntil the beginning of the century, bleeding management was similar in elective surgeries or exsanguination scenarios: clotting tests were used to guide blood product orders and, while awaiting these results, an aggressive resuscitation with crystalloids was recommended. The high mortality rate in severe hemorrhages managed with this strategy endorsed the need for a special resuscitation plan. As a result, modifications were recommended to develop a new clinical approach to these patients, called "Damage Control Resuscitation".
View Article and Find Full Text PDFAre crystalloid-based fluid expansion strategies still relevant in the first hours of trauma induced hemorrhagic shock?
Crit Care
December 2024
Department of Anesthesia and Intensive Care, Grenoble-Alpes University Hospital, Grenoble, France.
Background: Crystalloid-based fluid resuscitation has long been a cornerstone in the initial management of trauma-induced hemorrhagic shock. However, its benefit is increasingly questioned as it is suspected to increase bleeding and worsen coagulopathy. The emergence of alternative strategies like permissive hypotension and vasopressor use lead to a shift in early trauma care practices.
View Article and Find Full Text PDFPrehospital Trauma Compendium: Fluid Resuscitation in Trauma - a Position Statement and Resource Document of NAEMSP.
Prehosp Emerg Care
December 2024
Department of Emergency Medicine, North Memorial Health Level I Trauma Center, Robbinsdale, Minnesota.
Fluid resuscitation choices in prehospital trauma care are limited, with most Emergency Medical Services (EMS) agencies only having access to crystalloids. Which solution to use, how much to administer, and judging the individual risks and benefits of giving or withholding fluids remains an area of uncertainty. To address the role of crystalloid fluids in prehospital trauma care, we reviewed the available relevant literature and developed recommendations to guide clinical care.
View Article and Find Full Text PDFIs it time to reframe resuscitation in trauma?
Emerg Med J
November 2024
Critical Care Department, Northern Care Alliance NHS Foundation Trust, Salford, UK.
Article Synopsis
- * Current treatment focuses on damage control resuscitation techniques like hemorrhage control, haemostatic resuscitation, and permissive hypotension, although the evidence for permissive hypotension is not as strong as for other therapies.
- * The authors argue for a shift in focus towards diastolic blood pressure in bleeding trauma patients, as it is important for heart and brain function, proposing that this could lead to more effective resuscitation strategies.
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