In search of the optimal end points of resuscitation in trauma patients: a review.
Complete resuscitation from shock is one of the primary concerns of the surgeon taking care of injured patients. Traditionally, the return to normalcy of blood pressure, heart rate, and urine output has been the end point of resuscitation. Using these end points may leave a substantial number of patients, up to 50 to 85% in some series, in "compensated" shock, which if it persists may ultimately lead to the death of the patient. Because of this potential other end points are being used and include supernormal values for oxygen transport variables (cardiac index, oxygen delivery, and oxygen consumption), lactate, base deficit, and gastric intramucosal pH. We believe that the current data support the use of lactate, base deficit, and/or gastric intramucosal pH as the appropriate end points of resuscitation of trauma patients. The goal should be to correct one or all of three of these markers of tissue perfusion to normal within the initial 24 hours after injury.
Porter
J M
JM
University of California, Davis-East Bay, Oakland 94602, USA. jpcut2cure@aol.com
Ivatury
R R
RR
D000138:Acidosis; D015415:Biomarkers / Q000032:analysis; D005753:Gastric Mucosa / Q000737:chemistry; D006801:Humans; D006863:Hydrogen-Ion Concentration; D019344:Lactic Acid / Q000097:blood; D010100:Oxygen / Q000378:metabolism; D012151:Resuscitation; D012769:Shock / Q000209:etiology / Q000628:therapy*; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*
D015415:Biomarkers; D019344:Lactic Acid; D010100:Oxygen