Optimization of the intravascular volume in multiple trauma patients using esophageal Doppler – preliminary results

Overview

Objective:
The aim of study was to assess the effect of early optimization of intravascular volume using esophageal Doppler on blood lactate levels and organ dysfunction development in comparison with standard haemodynamic management in multiple trauma patients.

Design:
Prospective randomized controlled study.

Setting:
Interdisciplinary intensive care unit of a university teaching hospital.

Materials and Methods:
Multiple trauma patients with estimated blood loss of more than 2000 ml admitted to an interdisciplinary ICU were randomized to the protocol group with esophageal Doppler monitoring or the control group.We compared the degree of organ dysfunction during ICU stay, blood lactate levels on ICU admission and at 12/24 hours, basic demographic data and other parameters. Paired and unpaired t-test, Mann-Whitney test, Wilcoxon test and χ2 test were used for statistical analysis, P < 0.05 was considered statistically significant.

Results:
A total of 110 patients were evaluated in the Doppler (N = 54) and Control (N = 56) groups. Significant differences between the Doppler and Control groups were found in the decrease of blood lactate levels after 24 hours of ICU stay (Doppler vs. Control, 2.28 ± 0.75 mmol/l vs. 2.74 ± 1.44 mmol/l, Ρ = 0.039) and lower SOFA score at ICU discharge (Doppler vs. Control, 3 vs. 4, median, P = 0.043). Length of ICU stay did not differ (Doppler vs. Control, 8 days vs. 7 days, median, P = 0.6).

Conclusion:
Preliminary results of the study support the hypothesis that optimization of intravascular volume using esophageal Doppler in ventilated multiple trauma patients effectively eliminates occult hypoperfusion and improves blood lactate clearance.

Key words:
multiple trauma – hypoperfusion – esophageal Doppler – plasma volume optimization