Resuscitation Endpoints in Trauma

Napolitano, Lena M.

doi:10.1111/j.1778-428x.2005.tb00127.x

Cited by 12 publications

(5 citation statements)

References 53 publications

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“…Decompensated shock associated with abnormal macrovascular perfusion is generally recognizable. In contrast, states of compensatory shock are more difficult to detect given evidence suggesting that the use of traditional vital signs (eg, HR and SBP) alone may leave a large proportion of critically ill people in a state of persistent tissue hypoxia . The contribution of uncorrected tissue hypoxia to patient morbidity and mortality has been well established .…”

Section: Discussionmentioning

confidence: 99%

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Utility of admission lactate concentration, lactate variables, and shock index in outcome assessment in dogs diagnosed with shock

Zollo

Ayoob²,

Prittie

et al. 2019

J Vet Emergen Crit Care

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Objective:To determine whether admission venous plasma lactate concentration, calculated lactate variables, or shock index (SI) could discriminate hospital survivors from nonsurvivors in dogs admitted with shock. Design:Prospective investigation performed over a 19-month period.Setting: Large urban private teaching hospital.with initial peripheral venous plasma lactate concentration >2 mmol/L (18.0 mg/dL) and clinical and hemodynamic parameters consistent with shock. Interventions: None.Measurements and Main Results: Heart rate, systolic blood pressure, and venous plasma lactate concentrations were serially recorded at predefined time points and used to calculate SI (SI = heart rate/systolic blood pressure) and lactate variables, including lactime (time lactate > 2.0 mmol/L), lactate clearance ([lactate initial -lactate delayed ]/lactate initial × 100), and LAC AREA (area under the lactate concentration versus time curve). Primary outcome was survival to discharge.Overall survival rate was 61%. Admission venous plasma lactate concentration did not differ between groups (P = 0.2). Lactime was shorter in survivors versus nonsurvivors (P = 0.02). Lactate clearance at 1, 10, 16, 24, and 36 hours, and final lactate clearance were greater in survivors versus nonsurvivors (P < 0.05). LAC AREA at time intervals 0-1, 1-4, 4-10, 10-16, 16-24, 24-30, and 30-36 hours was larger in nonsurvivors versus survivors (P < 0.05). Total LAC AREA did not differ between groups (P = 0.09). Admission SI and time to normalize SI (SI < 0.9) were not different between survivors and nonsurvivors (P > 0.05). Conclusions:While admission venous plasma lactate concentration could not discriminate between hospital survivors and nonsurvivors, lactate variables showed clinical utility to predict outcome in dogs with shock. Further studies are needed to determine SI reference ranges and optimal SI cut-off values to improve its prognostic ability in sick dogs. K E Y W O R D Scanine, hypoperfusion, perfusion parameters, resuscitation Abbreviations: ED, emergency department; HR, heart rate; SI, shock index; SBP, systolic blood pressure.

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Section: Discussionmentioning

confidence: 99%

“…Various noninvasive and invasive methods intended to identify tissue hypoxia and guide resuscitation efforts have been reported . Traditional endpoints of resuscitation, including heart rate (HR) and systolic blood pressure (SBP), are easily obtained at the bedside.…”

Section: Introductionmentioning

confidence: 99%

Utility of admission lactate concentration, lactate variables, and shock index in outcome assessment in dogs diagnosed with shock

Zollo

Ayoob²,

Prittie

et al. 2019

J Vet Emergen Crit Care

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“…If such application would be successful, then it might help in decreasing indiscriminate use of crystalloid solutions that are known to worsen dilutional coagulopathy and hemorrhage. 19,20 In conjunction with vital signs and neurologic assessment, tissue oximetry may allow for the selection of a patient population that would benefit from early resuscitation while minimizing patient exposure to isotonic fluids. Furthermore, tissue oximetry using serial VOT may be able to guide therapy providing both feedback on the efficacy of treatment and an endpoint for resuscitation.…”

Section: Discussionmentioning

confidence: 99%

Prehospital dynamic tissue oxygen saturation response predicts in-hospital lifesaving interventions in trauma patients

Guyette

Gómez

Suffoletto

et al. 2012

Journal of Trauma and Acute Care Surgery

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BACKGROUND Tissue oximetry (StO2) plus a vascular occlusion test is a noninvasive technology that targets indices of oxygen uptake and delivery. We hypothesize that prehospital tissue oximetric values and vascular occlusion test response can predict the need for in-hospital lifesaving interventions (LSI). METHODS We conducted a prospective, blinded observational study to evaluate StO2 slopes to predict the need for LSI. We calculated the DeO2 slope using Pearson’s coefficients of regression (r2) for the first 25% of descent and the ReO2 slope using the entire recovery interval. The primary outcome was LSI defined as the need for emergent operation or transfusion in the first 24 hours of hospitalization. We created multivariable logistic regression models using covariates of age, sex, vital signs, lactate, and mental status. RESULTS We assessed StO2 in a convenience sample of 150 trauma patients from April to November of 2009. In-hospital mortality was 3% (95% confidence interval [CI], 1.1–7.6); 31% (95% CI, 24–39) were admitted to the intensive care unit, 6% (95% CI, 2.8–11.1) had an emergent operation, and 10% (95% CI, 5.7–15.9) required transfusion. Decreasing DeO2 was associated with a higher proportion of patients requiring LSI. In the multivariate model, the association between the need for LSI and DeO2, Glasgow Coma Scale, and age persists. CONCLUSION Prehospital DeO2 is associated with need for LSI in our trauma population. Further study of DeO2 is warranted to determine whether it can be used as an adjunct triage criterion or an endpoint for resuscitation. LEVEL OF EVIDENCE III, observational study.

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“…Investigators have suggested that resuscitating to a given blood pressure is fraught with complication and that other endpoints of resuscitation should be studied including lactate and measures of tissue oxygenation. 8,9 Capillary lactate: The point of care lactate device used in this study is marketed as being able to receive samples from capillary, venous or arterial sources. Arterial lactates are the gold standard but recent publications have indicated that venous lactate is equivalent.…”

Section: Determination Of the Optimal Cutoff For Sto2mentioning

confidence: 99%