see: [Trauma - Permissive hypotension](x-devonthink-item://3673A856-E48F-44F0-83B7-25775BEEF8BF?page=1034&start=4103&length=22&search=PERMISSIVE%20HYPOTENSION) and [systolic blood pressure](x-devonthink-item://3673A856-E48F-44F0-83B7-25775BEEF8BF?page=1033&start=2411&length=23&search=SYSTOLIC%20BLOOD%20PRESSURE) [Dunn - hypotensive resuscitation](x-devonthink-item://01DE45A3-FDFB-49DB-A716-D878018216FD) > MAP goal of ~ 50 > SBP ~ 80-90 prior to definitive surgical haemorrhage control likely higher values needed in elderly and pregnancy **indications** - leaking [[Abdominal Aortic Aneurysm|AAA]] - thoracic [[Aortic dissection]] - penetrating truncal and extremity trauma **+/-** - epistaxis - non-penetrating traumatic haemorrhage - [[Upper GI Bleed|gastrointestinal haemorrhage]] - [[Ectopic pregnancy]] - [[antepartum haemorrhage]] **contraindications** - controlled haemorrhage - *neurotrauma* (need SBP 100-110 MAP >80) - serious end-organ hypoperfusion (eg myocardial ischaemia, renal failure) - blast injury - pregnancy **rationale** - resus to normal BP can ↑ bleeding - contraindicated TBI because of risk of hypoperfusion - mostly for trauma but has general value in other forms of haemorrage eg UGIB or AAA **technique** - avoid unnecessary IVF or pressor agents - early haemorrhage control - *only use if early intervention to control bleeding is possible* ## Hybrid resuscitation - a form of hypotensive resuscitation - - used when ==time to definitive care is too long to allow hypotensive resuscitation== eg long duration retrievals - initial permissive hypotensive resus for 1 hour - clot strength is ~80% by 1 hour - exact duration depends on time to definitive care and pts tolerance of hypotension - gentle re-establishment of circulating blood volume following hypotensive phase - ceased if evidence of renewed haemorrhage with higher vascular pressures - may allow more stable clots to form at haemorrhage sites making them more resistant to breakdown when vascular pressure increases w/ more aggressive resus **Evidence**