Early cardiorespiratory findings after severe blunt thoracic trauma and their relation to outcome

This study examined the initial haemodynamic and oxygen transport patterns in 24 patients with severe blunt thoracic trauma in whom immediate monitoring with femoral and pulmonary artery catheters was required after admission to the intensive care unit. All patients required mechanical ventilation and were studied before receiving inhalational anaesthesia and within 12 h of injury. Two groups of patients were identified; nine patients (group 1) had an impaired left ventricular stroke work index (LVSWI) and 15 patients had a normal LVSWI (group 2). There were no significant diferences in the abbreviated injury scale score for the chest, the total injury severity score, or the mean ages of the two groups. There were significant diferences in stroke volume index, 32 versus 56 ml m −2 (P < 0.001), and cardiac index, 3.2 versus 5.3 l min−1 min−2 (P < 0.001), and therefore in oxygen delivery, 469 versus 852 ml min−1 m−2 (P < 0.001), despite apparently adequate volume expansion using the same protocol and clinical criteria in both groups. Oxygen consumption was not significantly diferent in the two groups, 135 versus 157ml min−1 m−2, because of a higher oxygen extraction ratio in group 1, 29 versus 19 per cent (P < 0.001), and hence lower mixed venous oxygen saturation, 73 versus 82 per cent (P < 0.02). Seven patients in group 1 died (78 per cent) compared with two in group 2 (13 per cent). Early depression of cardiac, function is associated with poor outcome in patients with thoracic trauma, and measurements of oxygen transport variables may influence resuscitation and the timing of surgical procedures.

[1]  J. Edwards,et al.  Hemodynamic and oxygen transport variables in cardiogenic shock secondary to acute myocardial infarction, and response to treatment. , 1990, The American journal of cardiology.

[2]  J. Siegel,et al.  Respiratory index/pulmonary shunt relationship: quantification of severity and prognosis in the post-traumatic adult respiratory distress syndrome. , 1989, Critical care medicine.

[3]  W. Shoemaker,et al.  Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. , 1988, Chest.

[4]  W. Shoemaker,et al.  Tissue oxygen debt as a determinant of lethal and nonlethal postoperative organ failure. , 1988, Critical care medicine.

[5]  J. Edwards,et al.  Oxygen consumption following trauma: a reappraisal in severely injured patients requiring mechanical ventilation , 1988 .

[6]  D. Trunkey.  Towards optimal trauma care. , 1985, Archives of emergency medicine.

[7]  R. Goris,et al.  Multiple-organ failure. Generalized autodestructive inflammation? , 1985, Archives of surgery.

[8]  W. Shoemaker,et al.  Probability of survival as a prognostic and severity of illness score in critically ill surgical patients , 1985, Critical care medicine.

[9]  W. Shoemaker,et al.  Hemodynamic and oxygen transport patterns in surviving and nonsurviving postoperative patients , 1985, Critical care medicine.

[10]  W C Shoemaker,et al.  Clinical trial of survivors' cardiorespiratory patterns as therapeutic goals in critically ill postoperative patients. , 1982, Critical care medicine.

[11]  R. Goris,et al.  Causes of death after blunt trauma. , 1982, The Journal of trauma.

[12]  W. Shoemaker,et al.  Clinical trial of an algorithm for outcome prediction in acute circulatory failure. , 1981, Critical care medicine.

[13]  W. Shoemaker,et al.  Pathogenesis of respiratory failure (ARDS) after hemorrhage and trauma: I. Cardiorespiratory patterns preceding the development of ARDS , 1980, Critical care medicine.

[14]  W. Shoemaker,et al.  Evaluation of the biologic importance of various hemodynamic and oxygen transport variables: Which variables should be monitored in postoperative shock? , 1979, Critical care medicine.

[15]  R. Hewitt,et al.  Cardiac contusion: a capricious syndrome. , 1975, Annals of surgery.

[16]  W. Shoemaker,et al.  Physiologic patterns in surviving and nonsurviving shock patients. Use of sequential cardiorespiratory variables in defining criteria for therapeutic goals and early warning of death. , 1973, Archives of surgery.

[17]  R. P. Noble,et al.  Studies of the circulation in clinical shock , 1943 .

[18]  D. Cuthbertson.  OBSERVATIONS ON THE DISTURBANCE OF METABOLISM PRODUCED BY INJURY TO THE LIMBS , 1932 .