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Vasopressors for Post-traumatic Hemorrhagic Shock: Friends or Foe?

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Annual Update in Intensive Care and Emergency Medicine 2020

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

Abstract

The administration of vasopressors to trauma patients in hemorrhagic shock is challenged primarily on the conceptual basis of “permissive hypotension” or “hypotensive resuscitation.” The phrase “pop the clot” is also frequently referenced to discourage targeting a physiologically appropriate blood pressure to minimize any disruption of hemostasis that has occurred following hemorrhage. It is crucial to recognize that much of the data to support such concepts are the result of heterogeneous animal studies. In addition, limited retrospective data in humans suggest that early vasopressor administration to trauma patients is associated with increased mortality. From a mechanistic perspective, it is theorized that vasopressor administration in bleeding patients will result in increased vasoconstriction and compromise end-organ function. However, several important concepts should be discussed regarding utilization of vasopressors in patients with traumatic hemorrhagic shock. First, there is growing evidence showing that vasopressor use is not associated with increased mortality after severe trauma. Recent randomized controlled trials have even indicated beneficial effects of vasopressin use after hemorrhagic shock. Potential benefits of vasopressors may be restoration of adequate perfusion blood pressure for vital organs and limitation of aggressive volume administration. Second, trauma is a complex and dynamic pathology that combines several causes of hypotension, including anesthesia-related, injury-related (hypovolemia and/or spinal cord injury), and trauma-induced vasoplegia. In conclusion, vasopressors should not be restricted from the trauma bay. Their prescription should be tailored to the clinical context and to the different time points of severe trauma management.

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Authors and Affiliations

  1. Department of Anesthesiology, Divisions of Trauma Anesthesiology and Critical Care Medicine, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA

    J. Richards

  2. Department of Anesthesia and Critical Care, Hôpital Beaujon, HUPNVS, AP-HP, Clichy, France

    T. Gauss

  3. Department of Anesthesia and Critical Care, Grenoble Alps Trauma Centre, Grenoble University Hospital, Grenoble, France

    P. Bouzat

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Correspondence to P. Bouzat .

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Editors and Affiliations

  1. Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

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Richards, J., Gauss, T., Bouzat, P. (2020). Vasopressors for Post-traumatic Hemorrhagic Shock: Friends or Foe?. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2020. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-37323-8_32

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  • DOI: https://doi.org/10.1007/978-3-030-37323-8_32

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