Contemporary hemodynamic monitoring, fluid responsiveness, volume optimization, and endpoints of resuscitation: an AAST critical care committee clinical consensus

Abstract

This article, on hemodynamic monitoring, fluid responsiveness, volume assessment, and endpoints of resuscitation, is part of a compendium of guidelines provided by the AAST (American Association for the Surgery of Trauma) critical care committee. The intention of these guidelines is to inform practitioners with practical clinical guidance. To do this effectively and contemporarily, expert consensus via the critical care committee was obtained. Strict guideline methodology such a GRADE (Grading of Recommendations Assessment, Development and Evaluation) was purposefully NOT used so as not to limit the possible clinical guidance. The critical care committee foresees this methodology as practically valuable to the bedside clinician.

Adult blunt hepatic injury: A Western Trauma Association critical decisions algorithm

“…Computed tomography (CT) imaging after an emergent operative intervention could help identify additional injuries, even if they might not warrant subsequent interventions 7,8 . Patients with a positive FAST examination who are responding to blood transfusion resuscitation using contemporary hemodynamic monitoring and end points of resuscitation 9 should undergo contrast-enhanced CT imaging.…”

Management of Decompensated Cirrhosis in the Surgical ICU: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document

“…Pulmonary artery catheter placement can ameliorate some of these challenges using measures of cardiac filling including mean pulmonary artery pressure, CO, and pulmonary capillary wedge pressure. 6 However, non-invasive monitoring has gained popularity and includes evaluation of mean arterial pressure (MAP), pulse pressure variation (PPV), point-of-care TTE (POC TTE), and arterial pulse contour technology. 6 MAP can be monitored using an intra-arterial catheter or noninvasive blood pressure monitoring to gauge appropriate tissue perfusion, with a MAP goal of ≥60-65 mm Hg.…”

“…6 However, non-invasive monitoring has gained popularity and includes evaluation of mean arterial pressure (MAP), pulse pressure variation (PPV), point-of-care TTE (POC TTE), and arterial pulse contour technology. 6 MAP can be monitored using an intra-arterial catheter or noninvasive blood pressure monitoring to gauge appropriate tissue perfusion, with a MAP goal of ≥60-65 mm Hg. 7 Intra-arterial catheters can also be used to quantify pulse pressure variation, with the caveat that ascites, intra-abdominal hypertension, and low systemic vascular resistance (SVR) may alter aortic compliance which affects PPV utilization.…”

Utilization and Efficacy of Resuscitation Endpoints in Trauma and Burn Patients: A Review Article

“…In 2020, the American Association for Surgery of Trauma released a committee consensus that avoided making clinical recommendations. 80 The Western Trauma Association, the Society of Critical Care Medicine, the World Health Organization, and the US Shock Society have not published guidelines for trauma resuscitation endpoints.…”