RELATIONSHIP BETWEEN SUPRANORMAL CIRCULATORY VALUES, TIME DELAYS, AND OUTCOME IN SEVERELY TRAUMATIZED PATIENTS

Objective: To describe the temporal patterns of hemodynamics and oxygen transport in survivors and nonsurvivors of severe trauma in relation to time delays, mortality, and morbidity. Design: Prospective, empiric analysis. Setting. University-run, inner city county hospital with a Level I trauma center. Patients: A series of 90 consecutively monitored, severely ill trauma patients. Methods. We followed 90 patients from admission through their hospital course, and divided the study group into patients with estimated blood loss of less-than-or-equal-to 3000 mL and those patients with an estimated blood loss of >3000 mL. For each patient, vital signs were recorded in the Emergency Department, operating room, recovery room, and surgical ICU. Hemodynamic and oxygen transport variables were measured at least every 12 hrs for 96 hrs postadmission. Final outcome and complications were recorded. Results. In the first 24 hrs, the values of 60 survivors were significantly higher than the values of 30 nonsurvivors for mean cardiac index (4.52 +/- 1.45 vs. 3.80 +/- 1.20 L/min/m2; p < .05), oxygen delivery (670 +/- 230 vs. 540 +/- 200 mL/min/m2;p < .01), and oxygen consumption (166 +/- 48 vs. 134 +/- 47 mL/min/m2;p < .01). Thirteen (50%) of 26 patients who never attained mean survivors' values (defined as the mean survivors' values listed above) died. Also, 12 (57%) of 21 patients who took >24 hrs to attain these values died. In contrast, only five (12%) of 43 patients who reached mean survivors' values in less-than-or-equal-to 24 hrs died. Thirty-five of 90 patients lost >3000 mL of blood; 17 of these 35 patients failed to reach survivors' values within 24 hrs, and 12 (71%) patients died. However, of 18 patients with an estimated blood loss of >3000 mL, who reached survivors' values in less-than-or-equal-to 24 hrs, only two (12%) died. The patients reaching survivors' values in less-than-or-equal-to 24 hrs, >24 hrs, or not at all had similar Injury Severity Scores (28 +/- 13, 26 +/- 13, and 26 +/- 12, respectively) and Trauma Scores (12 +/- 3, 13 +/- 3, and 12 +/- 3, respectively). Only six (12%) of 43 patients reaching survivors' values in less-than-or-equal-to 24 hrs developed adult respiratory distress syndrome (ARDS), while 27 (57%) of 47 patients showed these values in >24 hrs or never developed ARDS. Conclusions. Reaching supranormal circulatory values, especially within 24 hrs of injury, may improve survival and reduce the frequency of shock-related organ failure in severely traumatized patients.