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Vasopressor use following traumatic injury: protocol for a systematic review
  1. Mathieu Hylands1,
  2. Augustin Toma2,
  3. Nicolas Beaudoin3,
  4. Anne-Julie Frenette4,
  5. Frederick D'Aragon3,5,
  6. Emilie Belley-Côté2,6,
  7. Morten Hylander7,
  8. François Lauzier8,
  9. Reed Alexander Siemieniuk2,
  10. Emmanuel Charbonney4,
  11. Joey Kwong9,
  12. Jon Henrik Laake10,
  13. Gordon Guyatt2,
  14. Per Olav Vandvik11,
  15. Bram Rochwerg2,
  16. Robert Green12,
  17. Ian Ball13,
  18. Damon Scales14,
  19. Srinivas Murthy15,
  20. Sandro Rizoli16,
  21. Pierre Asfar17,
  22. François Lamontagne5,6
  1. 1Department of Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
  2. 2McMaster University, Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada
  3. 3Department of Anaesthesiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
  4. 4Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada
  5. 5Centre de recherche du CHU de Sherbrooke, Sherbrooke, Quebec, Canada
  6. 6Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
  7. 7Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
  8. 8Population Health and Optimal Health Practives Research Unit (Trauma—Emergency—Critical Care Medicine), Centre de Recherche du CHU de Québec—Université Laval, Quebec, Quebec, Canada
  9. 9Wuhan University, Center for Evidence-Based and Translational Medicine Zhongnan Hospital, Wuhan, China
  10. 10Oslo Universitetssykehus Ulleval, Oslo, Norway
  11. 11Norwegian Knowledge Centre for the Health Services, Oslo, Norway
  12. 12Department of Critical care, Dalhousie University, Halifax, Nova Scotia, Canada
  13. 13London Health Sciences Centre, London, Ontario, Canada
  14. 14Department of Critical Care, University of Toronto, Toronto, Ontario, Canada
  15. 15Department of Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada
  16. 16Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
  17. 17Centre Hospitalier Universitaire d'Angers, Angers, France
  1. Correspondence to Dr François Lamontagne; francois.lamontagne{at}


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 (, which will be disseminated in a standalone publication.

Trial registration number CRD42016033437.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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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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