Mean Arterial Pressure 65 mmHg as A Cut-Off Point for Successful Non-Operative Management of AAST Grade III Liver Injury Associated with Stable Hemodynamic on Blunt Abdominal Trauma Patients (A Serial Case Report)

Aims: To report 2 cases of blunt abdominal trauma with AAST Grade III liver injury and the mean arterial pressure as a cut-off point for successful non-operative management of AAST Grade III liver injury associated with stable hemodynamic.

Case Description: 2 cases of blunt abdominal trauma with AAST Grade III liver injury treated in Dr. Moewardi General Hospital Surakarta. The patients performed with stable hemodynamic. The patients were treated conservatively (non-operative). They got resuscitation and their vital signs were monitored strictly. The Mean Arterial Pressure was maintained in 65 mmHg with fluid resuscitation and blood transfusion.

Discussion: The decision to manage operatively or conservatively was made by evaluating hemodynamic state, not from the result of CT scan. CT scan can be useful for predicting the result of conservative treatment. Mean Arterial Pressure ≥ 65 mmHg can secure the macrocirculation functioning well. Prolonged arterial hypotension can make hypovolemic shock irreversible and increase mortality. In the other side, permissive hypotension during the acute phase of trauma is needed as a part of Damage Control Resuscitation to achieve hemostatic condition as soon as possible. We should keep cautious when we choose non-operative management, especially monitor the late complications such as delayed bleeding, DIC, sepsis and the sign of peritonitis that can be the indications to surgery.

Conclusions: The recommended initial target MAP for successful non-operative management of AAST Grade III liver injury associated with stable hemodynamic on blunt abdominal trauma patients is 65 mmHg to avoid prolonged arterial hypotension that can lead to irreversible shock and increase mortality.