Use of Vasopressors in Trauma

By caringsurgeon | Published 28 May 2022 | 1 Comment

Trauma is unlike other illnesses. The most common cause of shock in trauma is haemorrhage.

Vasopressor use in severely injured trauma patients is discouraged due to concerns that vasoconstriction will worsen organ perfusion and result in increased mortality and organ failure in hypotensive trauma patients. Richards JE, et al 2021

Can we use vasopressors in traumatic shock for resuscitation to increase blood pressure?

Answer – No

Few may think – ohh why “No”, I have used it many times and patients responded well.

then again you need to remind, how many patients finally survived after reaching to trauma ICU?

may not find the satisfactory answer – because Vasopressor kills trauma patients faster without achieving definitive haemorrhage control.

Reasons

Vasopressors cause peripheral vasoconstriction which again leads to poor perfusion and shock. temporarily you may notice a rise in blood pressure but finally, your patient will land up into shock and lactic acidemia & metabolic acidosis. which is associated with a higher mortality rate in trauma patients.
As soon you give vasopressors it will increase the patient’s blood pressure – the patient will rebleed or increases total blood loss, which further aggravates shock and finally death.
If the patient has already lost blood – due to lack of preload cardiac strain will increase and the patient may develop myocardial infarction and sudden death.

Never use vasopressors in Trauma Emergency without definitive haemorrhage control

Now again a question

Q: We should never use vasopressor in trauma?

Answer – We can use it in trauma victims only after definitive haemorrhage control and after the adequate restoration of body volume. Lactic acidemia is a good indicator of body perfusion.

Inotropes only useful in post-resuscitation or in Trauma ICU (Sepsis)

References

Richards JE, Harris T, Dünser MW, Bouzat P, Gauss T. Vasopressors in Trauma: A Never Event?. Anesthesia & Analgesia. 2021 Jul 1;133(1):68-79.
Gupta B, Garg N, Ramachandran R. Vasopressors: Do they have any role in hemorrhagic shock?. Journal of anaesthesiology, clinical pharmacology. 2017 Jan;33(1):3.