Noninvasive hemodynamic monitoring for early warning of adult respiratory distress syndrome in trauma patients.
OBJECTIVE
Traditionally hemodynamic patterns after adult respiratory distress syndrome (ARDS) are described after appropriate diagnostic criteria have been met, but studies begun after the diagnosis of ARDS miss the antecedent circulatory influences that may contribute to its development. This study tests the hypothesis that noninvasive monitoring before the appearance of ARDS may reveal early circulatory deficiencies that lead to this disorder. The aims of this study are as follows: (1) to describe the time course of hemodynamic and tissue perfusion patterns in severely traumatized postoperative patients from the period immediately after admission and during surgical repair to the time that ARDS developed or to hospital discharge in patients who did not develop ARDS, (2) to compare the time course of these patterns in survivors and nonsurvivors of ARDS, and (3) to suggest that reduced flow and perfusion may be early warning signs of ARDS. Prospective descriptive study of severely injured trauma patients noninvasively monitored in the emergency department, operating room, and intensive care unit (ICU). Early hemodynamic pattems were described in the surviving and nonsurviving patients who subsequently developed ARDS. The study was performed in a University-affiliated Level I trauma center and ICU.


METHODS
A consecutively monitored series of 60 severely injured patients were prospectively monitored by cardiac output, pulse oximetry (Sapo2), and transcutaneous O2 and co2 (Ptco2 and Ptc(co2)) sensors immediately after emergency admission. Twenty-nine patients developed ARDS in their ICU course, whereas 31 were discharged from the ICU and the hospital without developing ARDS.


RESULTS
Patients who developed ARDS had significantly lower cardiac index and Ptco2 and higher Ptc(co2) values beginning with the early stage compared with those who did not develop ARDS. Nonsurvivors of ARDS had lower Ptco2 values than did the survivors.


CONCLUSIONS
Early noninvasive monitoring in the emergency department, operating room, and ICU showed reduced cardiac and tissue perfusion functions in patients who subsequently developed ARDS. These patterns were more pronounced in the ARDS patients who died; these patterns may serve as early warning of ARDS.
Tatevossian
R G
RG
Department of Surgery, University of Southern California and the LAC+USC Medical Center, Los Angeles, USA.
Shoemaker
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WC
Wo
C C
CC
Dang
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AB
Velmahos
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GC
Demetriades
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D
D000328:Adult; D001785:Blood Gas Monitoring, Transcutaneous; D002140:California / Q000453:epidemiology; D002302:Cardiac Output; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D010092:Oximetry; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016019:Survival Analysis; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications* / Q000601:surgery