Introduction Worldwide, traumatic casualties are projected to exceed 8 million by year 2020. Haemorrhagic shock and brain injury are the leading causes of death following trauma. While intravenous fluids have traditionally been used to support organ perfusion in the setting of haemorrhage, recent investigations have suggested that restricting fluid therapy by tolerating more severe hypotension may improve survival. However, the safety of permissive hypotension remains uncertain, particularly among patients who have suffered a traumatic brain injury. Vasopressors preferentially vasoconstrict blood vessels that supply non-vital organs and capacitance vessels, thereby mobilising the unstressed blood volume. Used as fluid-sparing adjuncts, these drugs can complement resuscitative measures by correcting hypotension without diluting clotting factors or increasing the risk for tissue oedema.
Methods and analysis We will identify randomised control trials comparing early resuscitation with vasopressors versus placebo or standard care in adults following traumatic injury. Data sources will include MEDLINE, EMBASE, CENTRAL, clinical trial registries and conference proceedings. Two reviewers will independently determine trial eligibility. For each included trial, we will conduct duplicate independent data extraction and risk of bias assessment. We will assess the overall quality of the data for each individual outcome using the GRADE approach.
Ethics and dissemination We will report this review in accordance with the PRISMA statement. We will disseminate our findings at critical care and trauma conferences and through a publication in a peer-reviewed journal. We will also use this systematic review to create clinical guidelines (http://www.magicapp.org), which will be disseminated in a standalone publication.
Trial registration number CRD42016033437.
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Collaborators Canadian Critical Care Trials Group (CCCTG).
Contributors FLam and MH conceived the idea for this systematic review. FLam, MH, AT, NB, A-JF, FDA, EB-C, MH, FLau, RAS, EC, JHL, GG, POV, BR, DS, SM, SR and PA developed the methodology for the systematic review protocol. The manuscript was drafted by MH and FLam and revised by AT, NB, A-JF, FDA, EB-C, MHM, FLau, RAS, EC, JK, JHL, GG, POV, BR, RG, IB, DS, SM, SR and PA. MH developed the search strategy and will screen potential studies, perform duplicate independent data extraction, risk of bias assessment, GRADE assessment with AT, NB, A-JF and JK. MH will conduct the data synthesis. FLam will act as a third reviewer and arbitrator if necessary. FLam is the guarantor of the review.
Competing interests None declared.
Ethics approval Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data and analyses of the systematic review will be available to the public.
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