Normothermic rapid volume replacement in traumatic hypovolemia. A prospective analysis using a new device.
Inadequate infusion flow rates and hypothermia are significant problems encountered in managing traumatic hemorrhagic shock. The Rapid Solution Administration Set (RSAS) allows normothermic volume restoration at flow rates of up to 2200 mL/min via a single peripheral venipuncture. The RSAS was utilized in 33 consecutive multiple-trauma patients with a mean trauma score (TS) of 6.8. Admission systolic blood pressure averaged 66.9 mm Hg. A mean of 5692 mL of packed red blood cells, 5515 mL of blood products, and 12,052 mL of crystalloid solution per patient was infused within 24 hours of admission mostly via the RSAS. Mortality was 45% at 24 hours following arrival and 61% overall. The mortality was 93.8% (15/16) in patients with a TS of 5 or less and 29.4% (5/17) in patients with a TS over 5. The initial postinfusion patient temperatures averaged 35.2 degrees C. All abnormal preinfusion coagulation values normalized within 24 hours in the survivors, and no significant complications occurred with the use of the RSAS. The RSAS seems to provide an uncomplicated means of normothermic volume replacement. The 24-hour survival in potentially salvageable patients may be improved. Its use in patients with lethal injuries (TS less than or equal to 3) requires further evaluation.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001777:Blood Coagulation; D001831:Body Temperature; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012151:Resuscitation; D012774:Shock, Traumatic / Q000401:mortality / Q000628:therapy*