Early Low-Dose Noradrenaline Infusion as an Adjunct to Standard ATLS Protocol in the Resuscitation of Hypovolemic Shock among Polytrauma Patients with long bone fractures: A Prospective Comparative Study

Background: Hypovolemic shock remains a leading cause of early preventable mortality in polytrauma patients worldwide. Conventional Advanced Trauma Life Support (ATLS) guidelines emphasize aggressive fluid resuscitation; however, excessive crystalloid administration is associated with dilutional coagulopathy, tissue edema, and adverse outcomes. Early vasopressor support with low-dose noradrenaline may facilitate rapid hemodynamic stabilization while reducing fluid overload. Objectives: To compare the effectiveness of conventional ATLS protocol alone versus ATLS protocol combined with early low-dose noradrenaline infusion in adult polytrauma patients presenting with hypovolemic shock. Methods: This prospective comparative study included 60 adult polytrauma patients with hypovolemic shock, randomized into two groups: ATLS-only (n=30) and ATLS plus early noradrenaline (n=30). Primary outcomes included time to achieve systolic blood pressure (SBP) ≥90 mm Hg, fluid requirement in the first 3 hours, and time to heart rate normalization. Secondary outcomes included urine output at 3 hours, lactate clearance at 6 hours, Glasgow Coma Scale (GCS) improvement, ICU admission, and in-hospital mortality. Results: Baseline characteristics were comparable between groups. The noradrenaline group achieved target SBP significantly faster, required lower fluid volumes, and showed earlier heart rate normalization (p