Comparative analysis of the hemodynamic and metabolic effects of alternative fluid resuscitation strategies in critically ill patients with combined chest trauma and hemorrhagic shock: impact on oxygen delivery-consumption balance and coagulation homeostasis

ObjectiveThis study aimed to investigate the effects of different fluid resuscitation strategies on clinical efficacy, oxygen metabolism, coagulation function, and inflammatory response in critically ill patients with chest trauma complicated by hemorrhagic shock, so as to provide evidence for optimizing emergency treatment strategies.MethodsA total of 107 patients with severe chest trauma and hemorrhagic shock who were admitted to our hospital between June 2023 and April 2025 were retrospectively enrolled. According to the type of treatment received, patients were divided into two groups. The control group (n = 55) received conventional fluid resuscitation, while the observation group (n = 52) received restrictive fluid resuscitation. The two groups were compared in terms of fluid resuscitation parameters, oxygen metabolism indicators [mixed venous oxygen saturation (SvO2), oxygen consumption (VO2), oxygen delivery (DO2)], coagulation indicators [activated partial thromboplastin time (APTT), prothrombin time (PT), hematocrit (HCT)], inflammatory indicators [interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α)], as well as mortality and complication rates during resuscitation.ResultsCompared with the control group, the observation group had significantly lower fluid input volume (P < 0.05); there were no significant differences in early resuscitation time or colloid use between the two groups (P > 0.05). After resuscitation, SvO2, VO2, DO2, and HCT levels were all significantly increased compared with before resuscitation, while APTT, PT, IL-6, IL-10, and TNF-α levels were significantly decreased in both groups. The magnitude of changes in the observation group was significantly greater than in the control group (P < 0.05). During the resuscitation period, the survival rate of the observation group was significantly higher than that of the control group, while the incidence of ARDS, DIC, and MODS was significantly lower (P < 0.05).ConclusionCompared with conventional fluid resuscitation, restrictive fluid resuscitation shows more significant clinical advantages. Its application in patients with severe chest trauma complicated by hemorrhagic shock can reduce unnecessary fluid overload, more effectively improve oxygen metabolism, correct coagulation dysfunction, suppress inflammatory responses, thereby increasing survival rates and reducing the risk of complications.