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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.


Sources

1. BLIXT, C., ROOYACKER,SO, ISAKSSON, B. et al. Continuous on-line glucose measurement by microdialysis in a central vein. A pilot study. Crit Care. 2013, 17, R87.

2. BURSA, F., OLOS, T., PLEVA, L. et.al. Metabolism monitoring with microdialysis in the intensive care. Cas Lek Cesk. 2011, 150, 605–609.

3. COTTON, BA, DOSSETT, LA, HAUT, ER. et al. Multicenter validation of a simplified score to predict massive transfusion in trauma. J Trauma. 2010, 69, S33–S39.

4. DIMOPOULOU, N., ORFANOS, SE et. al. Kinetics of adipose tissue microdialysis-derived metabolites in critically ill septic patients:associations with sepsis severity and clinical outcome. Shock. 2011, 35, 342–348.

5. DONAT, R., SPAHN, B., CERNY, V. et. al. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care. 2013, 17, R76.

6. DOUGLAS, A., ALTUKRONI, M., UDY, AA et. al. The pharmacokinetics of cefazolin in patients undergoing elective & semi-elective abdominal aortic aneurysm open repair surgery. BMC Anesthesiol. 2011, 22, 11–15.

7. FARNEBO, S., SAMUELSSON, A., HENRIKSSON, J. et. al. Urea clearance: a new method to register local changes in blood flow in rat skeletal muscle based on microdialysis. Clin Physiol Funct Imaging. 2010, 30, 57–63.

8. FARNEBO, S., ZETTERSTEN, EK, SAMUELSSON, A. et al. Assessment of blood flow changes in human skin by microdialysis urea clearance. Microcirculation. 2011, 18, 198–204.

9. FEIFEI, S., CHUNYAN, D., JIANSHENG, X. et al. Biochemical Issues in Estimation of Cytosolic Free NAD/NADH Ratio. PLoS One. 2012, 7, e345–325.

10. KOPTERIDES, P., THEODORAKOPOULOU, M., NIKITAS, N. et. al. Red blood cell transfusion affects microdialysis-assessed interstitial lactate/pyruvate ratio in critically ill patients with late sepsis. Intensive Care Med. 2012, 38, 1843–1850.

11. LARACH, DB, KOFKE, WA, LE ROUX, P. Potential non-hypoxic/ischemic causes of increased cerebral interstitial fluid lactate/pyruvate ratio: a review of available literature. Neurocrit Care. 2011, 15, 609–622.

12. LARENTZAKIS, A., TOUTOUZAS, KG, PAPALOIS, A. et al. Porcine model of haemorrhagic shock with microdialysis monitoring. J Surg Res. 2013, 179, 177–182.

13. LEROUX, P. Haemoglobin management in acute brain injury. Curr Opin Crit Care. 2013, 19, 83–91.

14. LIU, X., KRUGER, PS, ROBERTS, MS. How to Measure Pharmacokinetics in Critically Ill Patients? Curr Pharm Biotechnol. 2011, 12, 2037–2043.

15. MANUEL, M., ULRIKE, N., THOMAS, B. et. al. Renaissance of base deficit for the initial assessment of trauma patients: a base deficit-based classification for hypovolemic shock developed on data from 16,305 patients derived from the TraumaRegister DGU®. Crit Care. 2013, 17, R42.

16. MESSERER, M., DANIEL, RT, ODDO, M. Neuromonitoring after major neurosurgical procedures. Minerva Anestesiol. 2012, 78, 810–822.

17. OHASHI, H., KAWASAKI, N., FUJITANI, S. et. al. Utility of microdialysis to detect the lactate/pyruvate ratio in subcutaneous tissue for the reliable monitoring of haemorrhagic shock. J Smooth Muscle Res. 2009, 45, 269–278.

18. SAKR, Y., DUBOIS, MJ, DE BACKER, D. et al. Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med. 2004, 32, 1825–1831.

19. SAMUELSSON, A, FARNEBO, S., MAGNUSSON, B. et. al. Implications for burn shock resuscitation of a new in vivo human vascular microdosing technique (microdialysis) for dermal administration of noradrenaline. Burns. 2012, 38, 975–983.

20. SHOEMAKER, WC, APPEL, PL, KRAM, HB. Tissue oxygen debt as a determinant of lethal and nonlethal postoperative organ failure. Crit Care Med. 1988, 16, 1117–1120.

21. SIMON, F., KARLANDER, LE. Continous assessment of concentrations of cytokines in experimental injuriesof the extremity. Int J Clin Exp Med. 2009, 2, 354–362.

22. SUISTOMAA, M., RUOKONEN, E., KARI, A. et al. Time-pattern of lactate and lactate to pyruvate ratio in the first 24 hours of intensive care emergency admissions. Shock. 2000, 14, 8–12.

23. TYVOLD, SS, SOLLIGÅRD, E., GUNNES, S. et al. Bronchial microdialysis of cytokines in the epithelial lining fluid in experimental intestinal ischemia and reperfusion before onset of manifest lung injury. Shock. 2010, 34, 517–524.

24. WADE,CE, DEL JUNCO, DJ, HOLCOMB, JB. Variations between level I trauma centers in 24-hours mortality in severe injured patients requiring a massive transfusion. J Trauma. 2011, 71, 389–393.

25. WAELGAARD, L., DAHL, BM, KVARSTEIN, G. et. al. Tissue gas tension and tissue metabolites for detection of organ hypoperfusion and ischemia. Acta Anaesthesiol Scand. 2012, 56, 200–209.

26. WAELGAARD, L., THORGERSEN, EB, LINE, PD et. al. Microdialysis monitoring of liver grafts by metabolic parameters, cytokine production, and complement activation. Transplantation. 2008, 86, 1096–1103.

27. WAIBEL, BH, ROTONDO, MM. Damage control surgery: it‘s evolution over the last 20 years. Rev Col Bras Cir. 2012, 39, 314–321.

28. WIDEGREN, U., HICKNER, RC, JORFELDT, L. et al. Muscle blood flow response to mental stress and adrenaline infusion in man: microdialysis ethanol technique compared to (133)Xe clearance and venous occlusion plethysmography. Clin Physiol Funct Imaging. 2010, 30, 52–61.

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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