Base excess determined within one hour of admission predicts mortality in patients with severe pelvic fractures and severe hemorrhagic shock

Abstract

Background: Unstable pelvic ring fractures with exsanguinating hemorrhages are rare but potentially lifethreatening injuries. The aim of this retrospective study was to evaluate whether early changes in acidbase parameters predict mortality of patients with severe pelvic trauma and hemorrhagic shock. Methods: Data for 50 patients with pelvic ring disruption and severe hemorrhage were analyzed retrospectively. In all patients, the pelvic ring was temporarily stabilized by C-clamp. Patients with ongoing bleeding underwent laparotomy with extraand/or intraperitoneal pelvic packing, as required. Base excess, lactate, and pH were measured upon admission and at 1, 2, 3, 4, 6, 8, and 12 h postadmission. Patients were categorized as early survivors (surviving the first 12 h after admission) and nonsurvivors. Statistical analysis was performed by Mann-Whitney test; significance was assumed at p < 0.05. Receiver operating characteristic curves were generated for early mortality from each acid-base variable. Results: Sixteen patients (32%) were nonsurvivors due to hemorrhagic shock (n = 13) or severe traumatic brain injury (n = 3). Thirty-four patients were early survivors. Base excess, lactate, and pH significantly discriminated between early survivors and nonsurvivors. Base excess determined 1 h after admission discriminated most strongly, with an area under the receiver operating characteristic curve of 0.915 (95% confidence interval, 0.836-0.993; p < 0.001).Conclusion: Base excess, lactate, and pH discriminate early survivors from nonsurvivors suffering from severe pelvic trauma and hemorrhagic shock. Base excess measured 1 h after admission best predicted early mortality following pelvic trauma with concomitant hemorrhage.

Ethyl pyruvate ameliorates hepatic injury following blunt chest trauma and hemorrhagic shock by reducing local inflammation, NF-kappaB activation and HMGB1 release

“…The higher haemoglobin values in the ethyl pyruvate group compared to the control group also explain the difference with regard to the blood pressure between those two groups at the end of the resuscitation period. Considering that the base deficit is a known indicator for trauma severity, outcome and resuscitation success [ 45 , 49 – 51 , 12 ], the better recovery in the ethyl pyruvate group underlines the beneficial potential of ethyl pyruvate as resuscitation fluid. Regarding the total protein content and tHb levels, the TxT+H/R_EP group exhibited higher protein values compared to the TxT+H/R_RL group and slightly lower values compared to the sham group (TxT+H/R_RL: 3.32 ± 0.28 g/dL vs .…”

“…lipopolysaccharide (LPS) and/or damage-associated-molecular-patterns (DAMP) such as HMGB1 caused by tissue damage, notably these hypoxic conditions result in a massive activation of the immune system, which carries a high risk for multiple organ dysfunction syndrome (MODS) and organ failure (e.g. lung, liver) [ 5 – 12 ].…”

Focus on: Diagnostic and prognosis of severely traumatized patients

“…These physiological parameters, which are accounted for in trauma scores, appear to be of the greatest prognostic value when assessed during the first hour after admission, as reported in this issue by Abt et al [7] from the Zurich Trauma Center. As well as physiological scores, anatomical scores are also very important, and combining both scores seems a reasonable approach.…”

Management of Bleeding Pelvic Fractures

“…Sequential measurements of base deficit and lactate levels in the early phase may help estimating the severity of pelvic hemorrhage. In the study by Abt et al (20), base deficit levels measured within 1 h of admission best predicted severe bleeding and early mortality. Salim et al (21) suggested that a sacroiliac joint disruption, female gender, and the duration of hypotension (systolic blood pressure <100 mmHg) would reliably indicate ongoing bleeding requiring angiographic embolization.…”