Non-operative management of blunt liver injury: a new protocol for selected hemodynamically unstable patients under hypotensive resuscitation.

Background: The objective of this study was to evaluate our new protocol for performing non-operative management for selected unstable patients under hypotensive resuscitation using improved diagnostic imaging techniques.

Methods: This retrospective study included 77 consecutive patients with blunt liver injury. They were divided into two groups: those treated before and those treated after the revision. Under the new protocol, we attempted to manage the patients non-operatively, usually with angioembolization, including those whose shock improved with fluid resuscitation and continuous loading, permitting the maintenance of a target systolic blood pressure of 80 mmHg. The outcomes of the two groups were evaluated and compared.

Results: While comparing the groups, although there was no change in the liver-related morbidity and mortality rates, the urgent and overall laparotomy rates and transfusion requirements in 24 h significantly decreased after the protocol revision. While comparing the subgroups of high-grade injury (AAST Grades 3-5), the overall laparotomy rates and transfusion requirements in 24 h significantly decreased after the protocol revision.

Conclusions: All the selected unstable patients were successfully managed non-operatively after the protocol revision. The decrease in laparotomy rates and transfusion requirements confirmed the feasibility of our new protocol for these selected patients.