Prospective, randomized trial of survivor values of cardiac index, oxygen delivery, and oxygen consumption as resuscitation endpoints in severe trauma
Bishop, M.H.; Shoemaker, W.C.; Appel, P.L.; Meade, P.; Ordog, G.J.; Wasserberger, J.; Wo, C.J.; Rimle, D.A.; Kram, H.B.; Umali, R.
Journal of Trauma 38(5): 780-787
1995
ISSN/ISBN: 0022-5282 PMID: 7760409 Document Number: 1154
The objective was to test prospectively supranormal values of cardiac index (CI), oxygen delivery index ( ovrhdot DO-2I), and oxygen consumption index ( ovrhdot VO-2I) as resuscitation goals to improve outcome in severely traumatized patients. We included patients gtoreq 16 years of age who had either (1) an estimated blood loss gtoreq 2000 mL or (2) a pelvic fracture and/or two or more major long bone fractures with gtoreq four units of packed red cells given within six hours of admission. The protocol resuscitation goals were CI gtoreq 4.5 L/min/n-2, ovrhdot DO-2I gtoreq 670 mL/min/m-2, and ovrhdot VO-2I gtoreq 166 mL/min/m-2 within 24 hours of admission. The control resuscitation goals were normal vital signs, urine output, and central venous pressure. The 50 protocol patients had a significantly lower mortality (9 of 50, 18% vs. 24 of 65, 37%) and fewer organ failures per patient (0.74 +- 0.28 vs. 1.62 +- 0.45) than did the 75 control patients. We conclude that increased CI, ovrhdot DO-2I and ovrhdot DO-2I seen in survivors of severe trauma are primary compensations that have survival value; augmentation of these compensations compared to conventional therapy decreases mortality.
Document emailed within 1 workday
