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 rece...

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Bibliographic Details
Published in:	Journal of the National Medical Association Vol. 86; no. 12; pp. 926 - 929
Main Authors:	MITCHELL, K. J, MONCURE, K. E, ONYEIJE, C, RAO, M. S, SIRAM, S
Format:	Journal Article
Language:	English
Published:	Thorofare, NJ Slack 01-12-1994 National Medical Association
Subjects:	Adolescent Adult Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blood Volume Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care Erythrocyte Transfusion Female Fluid Therapy Humans Infusions, Intravenous Intensive care medicine Isotonic Solutions Male Medical sciences Middle Aged Plasma Substitutes - administration & dosage Retrospective Studies Trauma Severity Indices Wounds, Penetrating - mortality Wounds, Penetrating - therapy Human Association Prognosis Penetrating injury Blood loss Trauma Resuscitation
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Summary:	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.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	0027-9684 1943-4693