Comparison of the Previous and Current Trauma-Related Shock Classifications: A Retrospective Cohort Study from a Level I Trauma Center

Jávor, Péter; Csonka, Endre; Butt, E.P.; Rárosi, Ferenc; Babik, Barna; Török, László; Varga, Endre; Hartmann, Petra

doi:10.1159/000516102

Cited by 5 publications

(5 citation statements)

References 41 publications

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“…The findings of Jávor et al's [ 17 ] investigation of 156 hypovolemic shocked individuals are consistent with our findings. Of these patients, 84 (53.9%) had affection in the thorax, and 75 (48.1%) had affection in the extremities.…”

Section: Discussionsupporting

confidence: 93%

“…Of these patients, 84 (53.9%) had affection in the thorax, and 75 (48.1%) had affection in the extremities. Their ISS had a median of 29 with an IQR (20–34) [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the first hour of resuscitation, the patients (unstable shocked) were given 1 L of crystalloid solution for fluid resuscitation ( according to recent ATLS guidelines). If the patient was still unstable after 1 Liter of fluid or had ongoing blood loss, O-negative blood transfusion was administered and type-specific blood was ordered and the trauma team activated massive transfusion protocol according to recent ATLS Guidelines even if normal hemoglobin [ 17 ].…”

Section: Statistical Planmentioning

confidence: 99%

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Evaluation of the role of repeated inferior vena cava sonography in estimating first 24 h fluid requirement in resuscitation of major blunt trauma patients in emergency department Suez Canal University Hospital

Ahmed,

Moussa,

Ali

et al. 2024

BMC Emerg Med

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Introduction The assessment of hemodynamic status in polytrauma patients is an important principle of the primary survey of trauma patients, and screening for ongoing hemorrhage and assessing the efficacy of resuscitation is vital in avoiding preventable death and significant morbidity in these patients. Invasive procedures may lead to various complications and the IVC ultrasound measurements are increasingly recognized as a potential noninvasive replacement or a source of adjunct information. Aimof this study The study aimed to determine if repeated ultrasound assessment of the inferior vena cava (diameter, collapsibility (IVC- CI) in major trauma patients presenting with collapsible IVC before resuscitation and after the first hour of resuscitation will predict total intravenous fluid requirements at first 24 h. Patients & methods The current study was conducted on 120 patients presented to the emergency department with Major blunt trauma (having significant injury to two or more ISS body regions or an ISS greater than 15). The patients(cases) group (shocked group) (60) patients with signs of shock such as decreased blood pressure < 90/60 mmHg or a more than 30% decrease from the baseline systolic pressure, heart rate > 100 b/m, cold, clammy skin, capillary refill > 2 s and their shock index above0.9. The control group (non-shocked group) (60) patients with normal blood pressure and heart rate, no other signs of shock (normal capillary refill, warm skin), and (shock index ≤ 0.9). Patients were evaluated at time 0 (baseline), 1 h after resucitation, and 24 h after 1st hour for:(blood pressure, pulse, RR, SO2, capillary refill time, MABP, IVCci, IVCmax, IVCmin). Results Among 120 Major blunt trauma patients, 98 males (81.7%) and 22 females (18.3%) were included in this analysis; hypovolemic shocked patients (60 patients) were divided into two main groups according to IVC diameter after the first hour of resuscitation; IVC repleted were 32 patients (53.3%) while 28 patients (46.7%) were IVC non-repleted. In our study population, there were statistically significant differences between repleted and non-repleted IVC cases regarding IVCD, DIVC min, IVCCI (on arrival) (after 1 h) (after 24 h of 1st hour of resuscitation) ( p-value < 0.05) and DIVC Max (on arrival) (after 1 h) (p-value < 0.001). There is no statistically significant difference (p-value = 0.075) between repleted and non-repleted cases regarding DIVC Max (after 24 h).In our study, we found that IVCci0 at a cut-off point > 38.5 has a sensitivity of 80.0% and Specificity of 85.71% with AUC 0.971 and a good 95% CI (0.938 – 1.0), which means that IVCci of 38.6% or more can indicate fluid responsiveness. We also found that IVCci 1 h (after fluid resuscitation) at cut-off point > 28.6 has a sensitivity of 80.0% and Specificity of 75% with AUC 0.886 and good 95% CI (0.803 – 0.968), which means that IVCci of 28.5% or less can indicate fluid unresponsiveness after 1st hour of resuscitation. We found no statistically significant difference between repleted and non-repleted cases regarding fluid requirement and amount of blood transfusion at 1st hour of resuscitation (p-value = 0.104). Conclusion Repeated bedside ultrasonography of IVCD, and IVCci before and after the first hour of resuscitation could be an excellent reliable invasive tool that can be used in estimating the First 24 h of fluid requirement in Major blunt trauma patients and assessment of fluid status.

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Section: Discussionsupporting

confidence: 93%

“…Of these patients, 84 (53.9%) had affection in the thorax, and 75 (48.1%) had affection in the extremities. Their ISS had a median of 29 with an IQR (20–34) [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Statistical Planmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of the role of repeated inferior vena cava sonography in estimating first 24 h fluid requirement in resuscitation of major blunt trauma patients in emergency department Suez Canal University Hospital

Ahmed,

Moussa,

Ali

et al. 2024

BMC Emerg Med

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show abstract

“…To date, the initial hemodynamic assessment of the injured relies on vital signs (VS) such as heart rate, and metabolic markers such as base deficit (BD) and lactate [4][5][6]. However, the specificity of VS and metabolic markers for hypovolemia remained questionable, since several factors such as medication, alcohol intoxication, administration of crystalloids (lactated ringer or saline), or even advanced age can diminish their reliability [7][8][9][10][11]. Furthermore, VS, BD, and lactate are global markers of shock that are maintained at near-normal levels until the compensatory mechanisms of the individual patient become fully exhausted.…”

Section: Introductionmentioning

confidence: 99%

Impairment of Mesenteric Perfusion as a Marker of Major Bleeding in Trauma Patients

Jávor

Donka

Horváth

et al. 2023

JCM

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The majority of potentially preventable mortality in trauma patients is related to bleeding; therefore, early recognition and effective treatment of hemorrhagic shock impose a cardinal challenge for trauma teams worldwide. The reduction in mesenteric perfusion (MP) is among the first compensatory responses to blood loss; however, there is no adequate tool for splanchnic hemodynamic monitoring in emergency patient care. In this narrative review, (i) methods based on flowmetry, CT imaging, video microscopy (VM), measurement of laboratory markers, spectroscopy, and tissue capnometry were critically analyzed with respect to their accessibility, and applicability, sensitivity, and specificity. (ii) Then, we demonstrated that derangement of MP is a promising diagnostic indicator of blood loss. (iii) Finally, we discussed a new diagnostic method for the evaluation of hemorrhage based on exhaled methane (CH4) measurement. Conclusions: Monitoring the MP is a feasible option for the evaluation of blood loss. There are a wide range of experimentally used methodologies; however, due to their practical limitations, only a fraction of them could be integrated into routine emergency trauma care. According to our comprehensive review, breath analysis, including exhaled CH4 measurement, would provide the possibility for continuous, non-invasive monitoring of blood loss.

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“…2 3 However, the specificity of VS and metabolic markers for hypovolemia remained questionable, since several factors such as medication, alcohol intoxication, administration of crystalloids (lactated Ringer or saline) or even advanced age can diminish their reliability. 3–7 Furthermore, the above-mentioned parameters are global markers of shock who are influenced positively by the compensatory mechanisms of the individual patient. Consequently, derangements of these indicators during bleeding may remain subtle in the preshock state and become apparent when it is already too late.…”

Section: Introductionmentioning

confidence: 99%

Detection of exhaled methane levels for monitoring trauma-related haemorrhage following blunt trauma: study protocol for a prospective observational study

et al. 2022

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Introduction Early recognition and effective treatment of internal bleeding impose a cardinal challenge for trauma teams. The reduction of the superior mesenteric artery (SMA) blood flow is among the first compensatory responses to blood loss, thus being a promising candidate as a diagnostic tool for occult haemorrhage. Unfortunately, methods for monitoring the SMA flow have not been elaborated to date. Nevertheless, animal experiments suggest that exhaled methane (CH4) levels correspond to the SMA perfusion. We hypothesise that real-time detection of CH4concentrations in the exhaled air is an applicable technique for the early recognition of haemorrhage in severely injured patients. We also hypothesise that exhaled CH4levels reflect the volume of blood loss more accurately than conventional markers of blood loss and shock such as shock index, haemoglobin, base deficit, lactate, end-tidal carbon dioxide and sublingual microcirculatory indices. Methods and analysis One hundred and eleven severely injured (Injury Severity Score ≥16), intubated, bleeding patients sustaining blunt trauma will be included in this prospective observational study. Blood loss will be detected with CT and estimated with CT-linked radiologic software. Exhaled CH4concentrations will be monitored by attaching a near-infrared laser technique-based photoacoustic spectroscopy apparatus to the exhalation outlet of the ventilator on patient arrival. The primary outcome is the volume of blood loss. Need for massive transfusion and 24-hour mortality will constitute secondary outcomes. The relation of exhaled CH4to study outcomes and its performance in predicting blood loss in comparison with conventional shock markers and microcirculatory indices will be tested. Ethics and dissemination Our protocol (ID: 5400/2021-SZTE) has been registered on ClinicalTrials.gov (NCT04987411) and complies with the Declaration of Helsinki and has been approved by the medical ethics committee at the University of Szeged (Ref.nr.:121/2021-SZTE RKEB). It is in data collection phase, theresults will be shared with the scientific community through publication in a peer-reviewed journal. Trial registration number NCT04987411ClinicalTrials.gov, registered on 27 July 2021.

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Comparison of the Previous and Current Trauma-Related Shock Classifications: A Retrospective Cohort Study from a Level I Trauma Center

Cited by 5 publications

References 41 publications

Evaluation of the role of repeated inferior vena cava sonography in estimating first 24 h fluid requirement in resuscitation of major blunt trauma patients in emergency department Suez Canal University Hospital

Evaluation of the role of repeated inferior vena cava sonography in estimating first 24 h fluid requirement in resuscitation of major blunt trauma patients in emergency department Suez Canal University Hospital

Impairment of Mesenteric Perfusion as a Marker of Major Bleeding in Trauma Patients

Detection of exhaled methane levels for monitoring trauma-related haemorrhage following blunt trauma: study protocol for a prospective observational study

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