Relationship between intensive care complications and costs and initial 24 h events of trauma patients with severe haemorrhage.
BACKGROUND
The correlation between the events occurring in the initial 24 h following traumatic injury and the outcome of patients presenting with hypovolaemic shock is not clear.


METHODS
27 patients who presented to a regional trauma centre with severe hypovolaemic shock were prospectively monitored. Evidence of severe hypovolaemia and shock was noted on admission with a mean systolic blood pressure of 73.8 mm Hg and a mean lactate level of 6.6 mM/l. The patients received a mean of 21.7 litres intravenous fluids during the first 24 h to maintain a mean systolic blood pressure >or=110 mm Hg and urine output of >or=50 ml/h. Multiple metabolic and physiological parameters were obtained prospectively and on an almost hourly basis for the first 24 h after admission. Patients were followed throughout their stay in hospital to record outcome, complications, total hospital costs and length of stay.


RESULTS
Using regression and multivariate analysis, adult respiratory distress syndrome was correlated with hypothermia and persistent lactic acidosis (R(2) = 0.65, p = 0.005). Coagulopathy was associated with hypothermia (R(2) = 0.43, p = 0.04). Length of stay and cost of hospitalisation were highly related to intensive care unit days, hospital-acquired infections and ventilator days (R(2) = 0.86, p = 0.03).


CONCLUSIONS
The initial 24 h events of trauma patients with haemorrhagic shock may have a significant impact on hospital costs and on complications developing later during hospitalisation.
Husari
A W
AW
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, American University of Beirut-Medical Center, P O Box 113-6044, Beirut 1107 2802, Lebanon. ah51@aub.edu.lb
Belzberg
H
H
Kassak
K
K
Dunham
C M
CM
D000328:Adult; D003422:Critical Care / Q000191:economics*; D006302:Health Services Research / Q000379:methods; D006470:Hemorrhage / Q000191:economics* / Q000209:etiology / Q000628:therapy; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008396:Maryland; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012769:Shock / Q000191:economics / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D014193:Trauma Centers / Q000191:economics; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications / Q000191:economics* / Q000628:therapy; D055815:Young Adult