Forgot calcium? Admission ionized-calcium in two civilian randomized controlled trials of prehospital plasma for traumatic hemorrhagic shock

Abstract BackgroundThere is still an ongoing battle against the Permissive Hypotension (PH) through Conventional Resuscitation Strategies (CR). Active fluid resuscitation in patients with traumatic shock can bring many problems, as it is known that standard high-volume resuscitation can exacerbate the lethal triad of acidemia, hypothermia, and coagulopathy. As a part of damage control resuscitation strategy, it can reduce mortality and shorten hospital stay, compared with the use of standard liquids. Moreover, its application is gradually receiving wider attention (1) . This review evaluated the effectiveness and safety of permissive hypotension resuscitation in adult patients with traumatic hemorrhagic shock.MethodsThe systematic review and meta-analysis were conducted according to PRISMA guidelines. We searched PubMed, EMBASE and Cochrane databases for randomized controlled trials (RCTs) from the beginning to March 2021 to compare the therapeutic effects of controlled fluid resuscitation and conventional fluid resuscitation on patients with traumatic hemorrhagic shock. Two reviewers independently conducted screening, data extraction and bias assessment. Data analysis was performed using Cochrane Collaboration Software Revman 5.2. The primary outcome was 30-day or in-hospital mortality. Secondary outcomes included blood routine index, coagulation function, resuscitation fluid use, complications, and length of hospital stay. Pooling was performed with a random-effects model.Results8 randomized controlled trials were screened out of 898 studies and 1593 patients were evaluated. The target blood pressure of the intervention group ranged from 50-90 mmHg in systolic pressure or mean arterial pressure ≥ 50 mmHg, while that of the control group was 65-110 mmHg systolic pressure or mean arterial pressure ≥ 60 mmHg. Only patients with penetrating injuries were evaluated in two studies, while the remaining six included blunt injuries. A statistically significant reduction in mortality was observed in the intervention group (RR = 0.70; 95%CI= 0.58-0.84; P < 0.05). Small heterogeneity was observed in the included articles (χ2 = 8.9; P = 0.18; I2 = 33%). The loss of platelet (PLT), hemoglobin (Hb) and body fluid was properly protected, the amount of resuscitation fluid was reduced, and the incidence of some adverse events was effectively reduced. There was no significant difference in coagulation time and hospital stay between the two groups.ConclusionsThis meta-analysis reveals the survival benefits of hypotension resuscitation in patients with traumatic hemorrhagic shock. The significant advantage is to promote the recovery of patients' physical function and reduce the incidence of treatment-related complications such as acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and multiple organ dysfunction syndrome (MODS), which reduces the mortality. Convincing evidences are provided based on these results, but larger, multicenter, randomized trials are needed to confirm the findings.

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Hypotensive Resuscitation among Trauma Patients

BioMed Research International ◽

10.1155/2016/8901938 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 13

Author(s):

Matthew M. Carrick ◽

Jan Leonard ◽

Denetta S. Slone ◽

Charles W. Mains ◽

David Bar-Or

Keyword(s):

Randomized Controlled Trials ◽

Hemorrhagic Shock ◽

Fluid Resuscitation ◽

Controlled Trial ◽

Hospital Setting ◽

Penetrating Trauma ◽

Controlled Trials ◽

Trauma Patients ◽

Randomized Controlled ◽

Hypotensive Resuscitation

Hemorrhagic shock is a principal cause of death among trauma patients within the first 24 hours after injury. Optimal fluid resuscitation strategies have been examined for nearly a century, more recently with several randomized controlled trials. Hypotensive resuscitation, also called permissive hypotension, is a resuscitation strategy that uses limited fluids and blood products during the early stages of treatment for hemorrhagic shock. A lower-than-normal blood pressure is maintained until operative control of the bleeding can occur. The randomized controlled trials examining restricted fluid resuscitation have demonstrated that aggressive fluid resuscitation in the prehospital and hospital setting leads to more complications than hypotensive resuscitation, with disparate findings on the survival benefit. Since the populations studied in each randomized controlled trial are slightly different, as is the timing of intervention and targeted vitals, there is still a need for a large, multicenter trial that can examine the benefit of hypotensive resuscitation in both blunt and penetrating trauma patients.

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Abstracts #300082: Current Therapies in Nonalcoholic Fatty Liver Disease (NAFLD). A Meta-analysis of Randomized Controlled Trials

Endocrine Practice ◽

10.1016/s1530-891x(20)48249-7 ◽

2020 ◽

Vol 26 ◽

pp. 5

Author(s):

Emily Wood

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Randomized Controlled Trials ◽

Nonalcoholic Fatty Liver Disease ◽

Fatty Liver Disease ◽

Meta Analysis ◽

Controlled Trials ◽

Nonalcoholic Fatty Liver ◽

Randomized Controlled ◽

Current Therapies

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258 Ambulatory monitoring for heart failure patients: it is possible to improve survival and quality of life: a metanalysis of randomized controlled trials

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(07)60137-4 ◽

2007 ◽

Vol 6 (1) ◽

pp. 51-51

Author(s):

F CANARIOALMEIDA ◽

L AZEVEDO ◽

A COSTAPEREIRA

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Randomized Controlled Trials ◽

Ambulatory Monitoring ◽

Controlled Trials ◽

Heart Failure Patients ◽

Randomized Controlled

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The Effect of Partly Missing Covariates on Statistical Power in Randomized Controlled Trials With Discrete-Time Survival Endpoints

Methodology ◽

10.1027/1614-2241/a000121 ◽

2017 ◽

Vol 13 (2) ◽

pp. 41-60

Author(s):

Shahab Jolani ◽

Maryam Safarkhani

Keyword(s):

Randomized Controlled Trials ◽

Discrete Time ◽

Treatment Effect ◽

Survival Data ◽

Controlled Trials ◽

Missing Covariates ◽

Indicator Method ◽

Imputation Methods ◽

Randomized Controlled ◽

Baseline Covariates

Abstract. In randomized controlled trials (RCTs), a common strategy to increase power to detect a treatment effect is adjustment for baseline covariates. However, adjustment with partly missing covariates, where complete cases are only used, is inefficient. We consider different alternatives in trials with discrete-time survival data, where subjects are measured in discrete-time intervals while they may experience an event at any point in time. The results of a Monte Carlo simulation study, as well as a case study of randomized trials in smokers with attention deficit hyperactivity disorder (ADHD), indicated that single and multiple imputation methods outperform the other methods and increase precision in estimating the treatment effect. Missing indicator method, which uses a dummy variable in the statistical model to indicate whether the value for that variable is missing and sets the same value to all missing values, is comparable to imputation methods. Nevertheless, the power level to detect the treatment effect based on missing indicator method is marginally lower than the imputation methods, particularly when the missingness depends on the outcome. In conclusion, it appears that imputation of partly missing (baseline) covariates should be preferred in the analysis of discrete-time survival data.

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