Left ventricular function after severe trauma.
OBJECTIVE
To evaluate cardiac function at the early phase of severe trauma.


METHODS
Prospective, clinical study.


METHODS
Anesthesiological Intensive Care Unit.


METHODS
7 consecutive patients admitted after severe trauma (ISS: 38 +/- 9, mean +/- SD), without preexisting cardiac disease.


METHODS
Each patient received midazolam and sufentanyl for sedation. Right heart catheterization (Swan-Ganz) and transesophageal echocardiography (TEE) were performed. The fractional area change (FAC) of the left ventricle was calculated within 6 h following trauma and at day 1 and day 2 in order to evaluate left ventricular function.


RESULTS
All of the patients had a low FAC value < 50% at day 0 (43.2 +/- 2.4%, range 39-46%), which increased significantly at day 2 (52.5 +/- 4%, range 47-59%, p = 0.001), whereas heart rate and preload (assessed by left ventricular end diastolic area and pulmonary arterial occlusion pressure) were constant and afterload, assessed by systolic blood pressure, increased significantly between day 0 and day 2 (112 +/- 21 to 145 +/- 24 mmHg, p = 0.02).


CONCLUSIONS
The initial phase of severe trauma is associated with an abnormal cardiac function, suggested by a low FAC value. This myocardial dysfunction must be taken into account for early resuscitation after severe injury.
Smaïl
N
N
Centre Hospitalier Universitaire de Bicêtre, Département d'Anesthésie-Réanimation, Le Kremlin-Bicêtre, France.
Descorps Declère
A
A
Duranteau
J
J
Vigué
B
B
Samii
K
K
D000328:Adult; D002407:Catheterization, Swan-Ganz; D017548:Echocardiography, Transesophageal; D006439:Hemodynamics; D006801:Humans; D015601:Injury Severity Score; D009104:Multiple Trauma / Q000150:complications* / Q000628:therapy; D011446:Prospective Studies; D012151:Resuscitation; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology