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Non‐operative management of blunt liver injury: a new protocol for selected hemodynamically unstable patients under hypotensive resuscitation
Author(s) -
Mitsusada Makoto,
Nakajima Yasushi,
Shirokawa Masamitsu,
Takeda Toshiaki,
Honda Hideki
Publication year - 2014
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.19
Subject(s) - medicine , laparotomy , resuscitation , blunt , shock (circulatory) , blood transfusion , surgery , protocol (science) , anesthesia , retrospective cohort study , radiology , alternative medicine , pathology
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.