Admission base deficit is superior to lactate in identifying shock and resuscitative needs in trauma patients

Davis, James W.; Sue, Lawrence P.; Dirks, Rachel; Kaups, Krista L.; Kwok, Amy M.; Wolfe, Mary M.; Lilienstein, Jordan T.; Bilello, John F.

doi:10.1016/j.amjsurg.2020.10.005

Cited by 16 publications

(20 citation statements)

References 13 publications

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“…Correlat on between pat ents' IVC flatness ndex and shock ndex, Glasgow Coma Score, Injury Sever ty Score, lactate level and base def c t Correlat on Coeff c ent patients 23. In our study, first admission base deficit was found to be worse in flat IVC patients than non-flat IVC patients.Nguyen et al and Liao et al found in their studies that resuscitation of flattened IVC patients required significantly higher amounts of crystalloids and blood products compared to non-flattened IVC patients.17,22 Matsumoto et al in their study with blunt torso trauma patients that flat IVC is an indication of hemodynamic deterioration and requires early blood transfusion in trauma patients.6 On the other hand, Radomski et al, in their study with blunt trauma patients, stated that IVC size in trauma patients was not associated with emergency transfusion 4.…”

supporting

confidence: 46%

The Role of Flatness Index of Inferior Vena Cava in Early Hypovolemic Shock Concerning Blunt Torso Trauma Patients

Kavak

ERTAN

Seki

et al. 2022

Ankara Eğitim Ve Araştırma Hastanesi Tıp Dergisi

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AIM: Our aim is to evaluate the role of flatness of index of Inferior Vena Cava (IVC) with early hypovolemic shock in blunt torso trauma patients. MATERIAL AND METHOD: In the computed tomography (CT) scan, patients with flatness index below 2 were considered as flat IVC patients, and those with 2 or more were considered as non-flattened IVC patients. Demographic data, comorbidities, trauma mechanism, Injury Severity Score (ISS), Glasgow Coma Score (GCS), lactate level, base excess, shock index (SI), clinical outcomes within 24 hours, and mortality of the flat IVC patients and non-flattened IVC patients were compared. RESULTS: 116 (30.6%) were found to have a flat IVC and 263 (69.4%) patients were found to have a non-flattened IVC. There was no significant difference between flat IVC patients and non-flattened IVC patients in terms of age, gender, comorbidity, and trauma mechanism (p>0.05). Flat IVC patients had a higher SI of 0.9 and above (p

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supporting

confidence: 46%

The Role of Flatness Index of Inferior Vena Cava in Early Hypovolemic Shock Concerning Blunt Torso Trauma Patients

Kavak

ERTAN

Seki

et al. 2022

Ankara Eğitim Ve Araştırma Hastanesi Tıp Dergisi

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“…Base deficit and lactate are both reliable measures of hypovolemic shock and global ischemia 16 . We observed that the development of ARLIC was associated with shock severity at the initial presentation as measured by significant metabolic acidosis.…”

Section: Discussionmentioning

confidence: 77%

Life over limb: Arterial access-related limb ischemic complications in 48-hour REBOA survivors

Laverty

Treffalls

McEntire

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Resuscitative endovascular balloon occlusion of the aorta (REBOA) is increasingly used in some trauma settings. Arterial access-related limb ischemic complications (ARLICs) resulting from the femoral arterial access required for REBOA are largely under reported. We sought to describe the incidence of these complications and the clinical, technical, and device factors associated with their development. METHODS:This was a retrospective cohort study of records of adult trauma patients from the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute care surgery registry between October 2013 and September 2020 who had REBOA and survived at least 48 hours. The primary outcome was ARLIC, defined as clinically relevant extremity ischemia or distal embolization. Relevant factors associated with ARLIC were also analyzed. RESULTS:Of 418 identified patients, 36 (8.6%) sustained at least one ARLIC; 22 with extremity ischemia, 25 with distal embolism, 11 with both. Patient demographics and injury characteristics were similar between ARLIC and no ARLIC groups. Access-related limb ischemic complication was associated with larger profile devices ( p = 0.009), cutdown access technique ( p = 0.02), and the presence of a pelvic external fixator/binder ( p = 0.01). Patients with ARLIC had higher base deficit ( p = 0.03) and lactate ( p = 0.006).One hundred fifty-six patients received tranexamic acid (TXA), with 22 (14%) ARLICs. The rate of TXA use among ARLIC patients was 61% (vs. 35% TXA for non-ARLIC patients, p = 0.002). Access-related limb ischemic complication did not result in additional in-hospital mortality, however, ARLIC had prolonged hospital LOS (31 vs. 24 days, p = 0.02). Five ARLIC required surgical intervention, three patch angioplasty (and two with associated bypass), and four ARLIC limbs were amputated. CONCLUSION:Femoral artery REBOA access carries a risk of ARLIC, which is associated with unstable pelvis fractures, severe shock, and strongly with the administration of TXA. Use of lower-profile devices and close surveillance for these complications is warranted in these settings and caution should be exercised when using TXA in conjunction with REBOA.

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“…A total of 468 predominantly (77.8%) male patients were included in the current study. The median age of the patients was 49 (33.3-64.0) years, the Injury Severity Score (ISS) was 25 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), and the new ISS (NISS) was 29 . The median intensive care unit (ICU) length of stay was 9 (4-16) days.…”

Section: Resultsmentioning

confidence: 99%

“…Conversely, Halbgebauer et al reported a significantly higher IL-6 concentration in polytrauma patients with hemorrhagic shock compared with those suffering from multiple traumas without an accompanying shock [ 28 ]. In clinical practice, base excess and lactate are often used as surrogates for the severity of shock [ 29 ]. In the current study, the median BE in the high-IL-6 group was significantly lower compared with the low-IL-6 group.…”

Section: Discussionmentioning

confidence: 99%

High Interleukin-6 Plasma Concentration upon Admission Is Predictive of Massive Transfusion in Severely Injured Patients

Weichselbaum

Oberladstätter

Schlimp

et al. 2021

JCM

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Severe bleeding remains a prominent cause of early in-hospital mortality in major trauma patients. Thus, prompt prediction of patients at risk of massive transfusion (MT) is crucial. We investigated the ability of the inflammatory marker interleukin (IL)-6 to forecast MT in severely injured trauma patients. IL-6 plasma levels were measured upon admission. Receiver operating characteristic curves (ROCs) were calculated, and sensitivity and specificity were determined. In this retrospective study, a total of 468 predominantly male (77.8%) patients, with a median injury severity score (ISS) of 25 (17–34), were included. The Youden index for the prediction of MT within 6 and 24 h was 351 pg/mL. Patients were dichotomized into two groups: (i) low-IL-6 < 350 pg/mL and (ii) high-IL-6 ≥ 350 pg/mL. IL-6 ≥ 350 pg/mL was associated with a lower prothrombin time index, a higher activated partial thromboplastin time, and a lower fibrinogen concentration compared with IL-6 < 350 pg/mL (p <0.0001 for all). Thromboelastometric parameters were significantly different between groups (p <0.03 in all). More patients in the high-IL-6 group received MT (p <0.0001). The ROCs revealed an area under the curve of 0.76 vs. 0.82 for the high-IL-6 group for receiving MT in the first 6 and 24 h. IL-6 ≥ 350 pg/mL predicted MT within 6 and 24 h with a sensitivity of 45% and 58%, respectively, and a specificity of 89%. IL-6 ≥ 350 pg/mL appears to be a reasonable early predictor for coagulopathy and MT within the first 6 and 24 h intervals. Large-scale prospective studies are warranted to confirm these findings.

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Admission base deficit is superior to lactate in identifying shock and resuscitative needs in trauma patients

Cited by 16 publications

References 13 publications

The Role of Flatness Index of Inferior Vena Cava in Early Hypovolemic Shock Concerning Blunt Torso Trauma Patients

The Role of Flatness Index of Inferior Vena Cava in Early Hypovolemic Shock Concerning Blunt Torso Trauma Patients

Life over limb: Arterial access-related limb ischemic complications in 48-hour REBOA survivors

High Interleukin-6 Plasma Concentration upon Admission Is Predictive of Massive Transfusion in Severely Injured Patients

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