DCR-like restrictive resuscitation is associated with enhanced oxygen metabolism, coagulation recovery, and reduced inflammation in severe chest trauma and shock.

Background: The optimal fluid resuscitation strategy for severe chest trauma with hemorrhagic shock remains debated, with limited evidence incorporating comprehensive physiological endpoints. This study compared a restrictive (damage-control resuscitation-like) strategy versus conventional crystalloid-predominant resuscitation in this high-risk population. Methods: This single-center retrospective cohort study used propensity score matching (1:1) to balance age, sex, Injury Severity Score, and shock severity, yielding 200 matched patients (100 per group). Outcomes included 28-day survival, major complications (ARDS, DIC, MODS), ventilator- and ICU-free days, and serial (0-72 h) assessments of oxygen metabolism (SvO Results: The restrictive group received significantly less total fluid (1985 ± 325 vs. 2846 ± 492 mL, Conclusion: In this observational, single-center study, a DCR-like restrictive strategy was associated with superior physiological trajectories and improved short-term clinical outcomes compared with conventional resuscitation. These hypothesis-generating findings do not establish causality and underscore the need for prospective randomized controlled trials before any practice change.