Evaluation of massive volume replacement in the penetrating trauma patient.
The records of 163 penetrating trauma patients who required surgery in a 36-month period between 1988 and 1990 were reviewed. Those patients with head trauma were excluded. Thirty patients were identified as having: similar Injury Severity Scores (ISS), received at least 8 L of crystalloid, and received at least 4 units of packed red blood cells during the first 24 hours after admission. There were 22 (73%) survivors and 8 (27%) nonsurvivors. Charts were reviewed for a variety of variables to determine which characteristics distinguished nonsurvivors from survivors. The mean ISS was 30.5 +/- 5.5. As a group, nonsurvivors received more blood transfusions (14.9 +/- 4.9 versus 5.0 +/- 1.14), had longer durations of shock (55.6 +/- 18 minutes versus 19.3 +/- 11.7 minutes), and had lower core body temperatures (92.6 degrees F +/- 2.2 versus 95.1 degrees F +/- 2.4) than survivors. Nonsurvivors also had lower hemoglobin levels (7.84 +/- 1 versus 9.1 +/- 2.3) and platelet counts (134.2 +/- 14.1 versus 188.6 +/- 6.3) than survivors. In addition, nonsurvivors demonstrated greater incidence of three major risk factors than did the survivors: hypothermia (75% versus 41%), acidosis (100% versus 27%), and coagulopathy (62% versus 4.5%). Therapeutic measures to limit these risk factors for increased mortality may maximize the chance of survival in these patients.
Mitchell
K J
KJ
Department of Surgery, Howard University College of Medicine, Washington, DC.
Moncure
K E
KE
Onyeije
C
C
Rao
M S
MS
Siram
S
S
D000293:Adolescent; D000328:Adult; D001810:Blood Volume; D000077324:Crystalloid Solutions; D017707:Erythrocyte Transfusion; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007262:Infusions, Intravenous; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage*; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014950:Wounds, Penetrating / Q000401:mortality / Q000628:therapy*
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes