Vasopressin for therapy of persistent traumatic hemorrhagic shock. The VITRIS.at study

被引：34

作者：

Lienhart H.G. ^{[1
]}

Wenzel V. ^{[1
,19
]}

Braun J. ^{[2
]}

Dörges V. ^{[3
]}

Dünser M. ^{[4
]}

Gries A. ^{[2
,5
]}

Hasibeder W.R. ^{[6
]}

Helm M. ^{[7
,8
]}

Lefering R. ^{[9
,10
]}

Schlechtriemen T. ^{[11
,12
]}

Trimmel H. ^{[13
,14
]}

Ulmer H. ^{[15
]}

Ummenhofer W. ^{[16
,17
]}

Voelckel W.G. ^{[1
,14
]}

Waydhas C. ^{[10
,18
]}

Lindner K. ^{[1
]}

机构：

[1] Univ.-Klinik für Anästhesie und Allg. Intensivmedizin, Medizinische Universität Innsbruck

[2] Deutsche Rettungsflugwacht, Stuttgart

[3] Universitätsklinik für Anästhesie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel

[4] Klinik für Intensivmedizin, Inselspital, Universitätskliniken, Bern

[5] Klinik für Anästhesie und Intensivmedizin, Ruprecht-Karls-Universität, Heidelberg

[6] Klinik für Anästhesie und Intensivmedizin, Allg. Krankenhaus, Ried im Innkreis

[7] Abteilung für Anästhesie und Intensivmedizin, Bundeswehrkrankenhaus, Ulm

[8] Luftrettungsdienst, Bundeswehr, Ulm

[9] Abteilung für Unfallchirurgie, Krankenhaus Merheim, Köln

[10] Traumaregister, Deutsche Gesellschaft für Unfallchirurgie, Köln

[11] Abteilung für Anästhesie und Intensivmedizin, Städtisches Klinikum, Saarbrücken

[12] Luftrettung, ADAC, München

[13] Abteilung für Anästhesie, Intensiv- und Notfallmedizin, Allg. Krankenhaus, Wiener Neustadt

[14] Flugrettung, ÖAMTC, Wien

[15] Department für Medizinische Statistik, Informatik und Gesundheitsökonomie, Medizinische Universität, Innsbruck

[16] Klinik für Anästhesie und Intensivmedizin, Universitätskliniken, Basel

[17] Schweizerische Rettungsflugwacht (REGA), Zürich

[18] Klinik für Unfallchirurgie, Universitätskliniken, Essen

[19] Univ.-Klinik für Anästhesie und Allg. Intensivmedizin, Medizinische Universität Innsbruck, 6020 Innsbruck

来源：

Der Anaesthesist | 2007年 / 56卷 / 2期

关键词：

Air rescue service; Emergency medical service; Helicopter; Shock therapy; Traumatic hemorrhagic shock; Vasopressin; VITRIS study;

D O I：

10.1007/s00101-006-1114-4

中图分类号：

学科分类号：

摘要：

While fluid management is established in controlled hemorrhagic shock, its use in uncontrolled hemorrhagic shock is being controversially discussed, because it may worsen bleeding. In the irreversible phase of hemorrhagic shock that was unresponsive to volume replacement, airway management and catecholamines, vasopressin was beneficial due to an increase in arterial blood pressure, shift of blood away from a subdiaphragmatic bleeding site towards the heart and brain and decrease of fluid resuscitation requirements. The purpose of this multicenter, randomized, controlled, international trial is to assess the effects of vasopressin (10 IU IV) vs. saline placebo IV (up to 3 injections at least 5 min apart) in patients with prehospital traumatic hemorrhagic shock that persists despite standard shock treatment. The study will be carried out by helicopter emergency medical service teams in Austria, Germany, Czech Republic, Portugal, the Netherlands and Switzerland. Inclusion criteria are adult trauma patients with presumed traumatic hemorrhagic shock (systolic arterial blood pressure <90 mmHg) that does not respond to the first 10 min of standard shock treatment (endotracheal intubation, fluid resuscitation and use of vasopressors) after arrival of the first emergency physician at the scene. The time window for randomization will close after 30 min of shock treatment. Exclusion criteria are terminal illness, no intravenous access, age <18 years, injury >60 min before randomization, cardiac arrest before randomization, presence of a do-not-resuscitate order, untreated tension pneumothorax, untreated cardiac tamponade, or known pregnancy. Primary study end-point is the hospital admission rate, secondary end-points are hemodynamic variables, fluid resuscitation requirements and hospital discharge rate. © 2007 Springer Medizin Verlag.

引用

页码：145 / 150

页数：5

共 38 条

[1]

Bickell W.H., Bruttig S.P., Millnamow G.A., Et al., The detrimental effects of intravenous crystalloid after aortotomy in swine, Surgery, 110, pp. 529-536, (1991)

[2]

Bickell W.H., Wall Jr M.J., Pepe P.E., Et al., Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries, N Engl J Med, 331, pp. 1105-1109, (1994)

[3]

Chan L., Bartfield J.M., Reilly K.M., The significance of out-of-hospital hypotension in blunt trauma patients, Acad Emerg Med, 4, pp. 785-788, (1997)

[4]

Chesnut R.M., Marshall L.F., Klauber M.R., Et al., The role of secondary brain injury in determining outcome from severe head injury, J Trauma, 34, pp. 216-222, (1993)

[5]

Coats T.J., Goode A., Towards improving pre-hospital trauma care, Lancet, 357, (2001)

[6]

Deakin C.D., Hicks I.R., AB or ABC: Pre-hospital fluid management in major trauma, J Accid Emerg Med, 11, pp. 154-157, (1994)

[7]

Dick W.F., Baskett P.J., Grande C., Et al., Recommendations for uniform reporting of data following major trauma - The Utstein style (as of July 17, 1999). An International Trauma Anaesthesia and Critical Care Society [ITACCS], Acta Anaesthesiol Belg, 51, pp. 18-38, (2000)

[8]

Eckstein M., Chan L., Schneir A., Palmer R., Effect of prehospital advanced life support on outcomes of major trauma patients, J Trauma, 48, pp. 643-648, (2000)

[9]

Ericsson B.F., Effect of vasopressin on the distribution of cardiac output and organ blood flow in the anesthetized dog, Acta Chir Scand, 137, pp. 729-738, (1971)

[10]

Ericsson B.F., Hemodynamic effects of vasopressin: An experimental study in normovolemic and hypovolemic anesthetized dogs, Acta Chir Scand, 414, SUPPL., pp. 1-29, (1971)

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