Intensity and duration of tissue ischemia in severe polytraumatized patients in dependent on duration of prehospital care, care in emergency and operation time registred by microdialysis
Authors:
Filip Burša; Leopold Pleva
Authors‘ workplace:
Lékařská Fakulta Ostravské university v Ostravě
; Letecká záchranná služba Moravskoslezského kraje
; Anesteziologicko resuscitační klinika Fakultní nemocnice Ostrava
Published in:
Úraz chir. 21., 2013, č.1
Overview
BACKGROUND:
Treatment of haemorhagic shock and trauma induced coagulopathy must be enough effective, rapid and aggressive to reduce morbidity and mortality of polytraumatized patients. Symptomatic or occult shock and the associated tissue ischemia leads to multi-organ dysfunction syndrome in critical ill patients. Tissue monitoring is possible by microdialysis. The aim of this study is to evaluate dependency of tissue hypoxia (L/P; lactate to pyruvate ratio) on length of care.
METHODS:
Adult polytraumatized patients with traumatic hemorrhagic shock were enrolled in this prospective, observational study. Microdialysis of the peripheral muscle tissue was performed. Monitoring included measurement of tissue lactate and pyruvate. Demographic data, timeline (TICU=prehospital care, care in emergency department, operation time) of care, haemoglobin and serum lactate levels were collected.
RESULTS:
Tissue lactate/pyruvate (L/P) ratio is dependent on timeline of care in inicial treatment period in severe trauma patients. Patients in group with TICU≤ 240 minutes had lower L/P ratio (22,9 versus 30,3), lower degree of ischemia and shorter ischemic period (1 hour versus 7,5 hours). Severe traumas with 17% higher ISS score, 21% higher L/P ratio and almoust double the serum lactate was transported by helicopter emergency medical servis as compared with ground-based emergency services in the same prehospital time.
CONCLUSION:
Ischemia of peripheral muscle tissue in traumatic hemorrhagic shock is dependent on speed of care in initial trauma period. Severe and longer duration of ischemia was observed in longer treated patients. Helicopter emergency medical servis transport severe traumas with severe shock and despite more technically demanding and more distant places of interventions is this transport faster.
Key words:
microdialysis, shock, lactate, prehospital, emergency.
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Resortní program výzkumu a vývoje – MZ III na léta 2010 – 2015, identifikační kód NT11371-5/2010 – účelová podpora IGA MZ ČR projektu Metabolická odezva organizmu u polytraumat.
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Surgery Traumatology Trauma surgeryArticle was published in
Trauma Surgery
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