Prospective, Randomized Trial of Survivor Values of Cardiac Index, Oxygen Delivery, and Oxygen Consumption as Resuscitation Endpoints in Severe Trauma

Abstract

The objective was to test prospectively supranormal values of cardiac index (CI), oxygen delivery index (DO2I), and oxygen consumption index (VO2I) as resuscitation goals to improve outcome in severely traumatized patients. We included patients > or = 16 years of age who had either (1) an estimated blood loss > or = 2000 mL or (2) a pelvic fracture and/or two or more major long bone fractures with > or = four units of packed red cells given within six hours of admission. The protocol resuscitation goals were CI > or = 4.5 L/min/m2, DO2I > or = 670 mL/min/m2, and VO2I > or = 166 mL/min/m2 within 24 hours of admission. The control resuscitation goals were normal vital signs, urine output, and central venous pressure. The 50 protocol patients had a significantly lower mortality (9 of 50, 18% vs. 24 of 65, 37%) and fewer organ failures per patient (0.74 +/- 0.28 vs. 1.62 +/- 0.45) than did the 75 control patients. We conclude that increased CI, DO2I, and VO2I seen in survivors of severe trauma are primary compensations that have survival value; augmentation of these compensations compared to conventional therapy decreases mortality.

TNF-α mutation affects the gene expression profiles of patients with multiple trauma

“…In survivors of severe trauma, increased oxygen delivery index, oxygen consumption index, and cardiac index are primary compensations that have survival value and augmentation of these compensations can decrease mortality. 27 Oxygen consumption and reduction of oxygen delivery to below a critical level produces ischemic metabolic insufficiency and then causes increasing of lactate generation. 28 Furthermore, blood lactate levels are tightly related to outcome in critically ill trauma patients.…”

Blood Tranfusion in Critically Ill Patients: State of the Art

“…Compensatory mechanisms for progressive euvolemic anemia include not only an increase in cardiac output (increased left ventricular emptying and tachycardia) but also a change in the oxygen extraction ratio from the erythrocyte itself. Prospective randomized trials [42][43][44] and an additional meta-analyses [38][39][40][41][42][43][44] have failed to confirm the benefit of achieving supranormal values of oxygen delivery and oxygen use. They have also raised the possibility that this strategy may result in worse clinical outcomes and increased mortality.…”

Revisão sistemática dos marcadores de otiminização da perfusão tecidual em ensaios clínicos aleatórios de cirurgias de alto risco

“…Study or Subgroup Bender, 1997Berlauk, 1991Bishop, 1995Boldt, 1998Bonazzi, 2002Boyd, 1993Chytra, 2007Conway, 2002Donati, 2007Fleming, 1992Gan, 2002Kapoor, 2008Lobo, 2000Lobo, 2006Lopes, 2007Mythen, 1995Pearse, 2005Polonen, 2000Sandham, 2003Shoemaker, 1988Shultz, 1985Sinclair, 1997Stone, 2003Takala, 2000Ueno, 1998Valentine, 1997Velmahos, 2000Venn, 2002Wakeling, 2005Wilson, 1999 Ziegler, 1997…”

“…Study or Subgroup Bishop, 1995Boldt, 1998Chytra, 2007Fleming, 1992Lobo, 2000Lobo, 2006Lopes, 2007Shoemaker, 1988Shultz, 1985 Total (95% CI) Total events Heterogeneity: Chi² = 3.01, df = 6 (P = 0.81); I² = 0% Test for overall effect: Z = 4.92 (P < 0.00001) Bender, 1997Berlauk, 1991Bishop, 1995Boldt, 1998Bonazzi, 2002Boyd, 1993Fleming, 1992Lobo, 2000Lobo, 2006Polonen, 2000Sandham, 2003Shoemaker, 1988Shultz, 1985Takala, 2000Ueno, 1998Valentine, 1997Velmahos, 2000Wilson, 1999 Ziegler, 1997…”

“…Total events Heterogeneity: Chi² = 36.08, df = 17 (P = 0.004); I² = 53% Test for overall effect: Z = 3.01 (P = 0.003) Bender, 1997Berlauk, 1991Bishop, 1995Boldt, 1998Bonazzi, 2002Boyd, 1993Fleming, 1992Kapoor, 2008Lobo, 2000Lobo, 2006Pearse, 2005Sandham, 2003Shoemaker, 1988Takala, 2000Ueno, 1998Valentine, 1997Velmahos, 2000Wilson, 1999 Total (95% CI) Total events Heterogeneity: Chi² = 29.12, df = 15 (P = 0.02); I² = 48% Test for overall effect: Z = 2.54 (P = 0.01) Heyland (1996), talvez a primeira revisão sistemática sobre estudos clínicos aleatórios designados para atingir valores supranormais de IC, IDO2 e IVO2 em pacientes críticos, atribuiu um rigor metodológico e selecionou apenas sete artigos de 64 identificados e concluiu que existe uma tendência não estatisticamente significativa de diminuição da taxa de mortalidade, risco Assim, há a necessidade de constante atualização científica para esse assunto tão complexo e contraditório, motivando esta revisão sistemática e todas as outras que ainda virão, na tentativa de elucidar, baseada na melhor evidência possível, todas as questões pertinentes (Cook and Guyatt 1994).…”