Abstract
Objective: To evaluate the effect of early optimization in the survival of severely injured patients. Summary Background Data: It is unclear whether supranormal ('optimal') hemodynamic values should serve as endpoints of resuscitation or simply as markers of the physiologic reserve of critically injured patients. The failure of optimization to produce improved survival in some randomized controlled trials may be associated with delays in starting the attempt to reach optimal goals. There are limited controlled data on trauma patients. Methods: Seventy-five consecutive severely injured patients with shock resulting from bleeding and without major intracranial or spinal cord trauma were randomized to resuscitation, starting immediately after admission, to either normal values of systolic blood pressure, urine output, base deficit, hemoglobin, and cardiac index (control group, 35 patients) or optimal values (cardiac index >4.5 L/min/m2, ratio of transcutaneous oxygen tension to fractional inspired oxygen >200, oxygen delivery index >600 mL/min/m2, and oxygen consumption index >170 mL/min/m2; optimal group, 40 patients). Initial cardiac output monitoring was done noninvasively by bioimpedance and, subsequently, invasively by thermodilution. Crystalloids, colloids, blood, inotropes, and vasopressors were used by predetermined algorithms. Results: Optimal values were reached intentionally by 70% of the optimal patients and spontaneously by 40% of the control patients. There was no difference in rates of death (15% optimal vs. 11% control), organ failure, sepsis, or the length of intensive care unit or hospital stay between the two groups. Patients from both groups who achieved optimal values had better outcomes than patients who did not. The death rate was 0% among patients who achieved optimal values compared with 30% among patients who did not. Age younger than 40 years was the only independent predictive factor of the ability to reach optimal values. Conclusions: Severely injured patients who can achieve optimal hemodynamic values are more likely to survive than those who cannot, regardless of the resuscitation technique. In this study, attempts at early optimization did not improve the outcome of the examined subgroup of severely injured patients.
| Original language | English |
|---|---|
| Pages (from-to) | 409-418 |
| Number of pages | 10 |
| Journal | Annals of Surgery |
| Volume | 232 |
| Issue number | 3 |
| DOIs | |
| State | Published - 2000 |
| Externally published | Yes |
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All Science Journal Classification (ASJC) codes
- Surgery
Cite this
Endpoints of resuscitation of critically injured patients : Normal or supranormal? A prospective randomized trial. / Velmahos, George C.; Demetriades, Demetrios; Shoemaker, William C.; Chan, Linda S.; Tatevossian, Raymond; Wo, C. C J; Vassiliu, Pantelis; Cornwell, Edward E.; Murray, James A.; Roth, Bradley; Belzberg, Howard; Asensio, Juan A.; Berne, Thomas V.
In: Annals of Surgery, Vol. 232, No. 3, 2000, p. 409-418.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Endpoints of resuscitation of critically injured patients
T2 - Normal or supranormal? A prospective randomized trial
AU - Velmahos, George C.
AU - Demetriades, Demetrios
AU - Shoemaker, William C.
AU - Chan, Linda S.
AU - Tatevossian, Raymond
AU - Wo, C. C J
AU - Vassiliu, Pantelis
AU - Cornwell, Edward E.
AU - Murray, James A.
AU - Roth, Bradley
AU - Belzberg, Howard
AU - Asensio, Juan A.
AU - Berne, Thomas V.
PY - 2000
Y1 - 2000
N2 - Objective: To evaluate the effect of early optimization in the survival of severely injured patients. Summary Background Data: It is unclear whether supranormal ('optimal') hemodynamic values should serve as endpoints of resuscitation or simply as markers of the physiologic reserve of critically injured patients. The failure of optimization to produce improved survival in some randomized controlled trials may be associated with delays in starting the attempt to reach optimal goals. There are limited controlled data on trauma patients. Methods: Seventy-five consecutive severely injured patients with shock resulting from bleeding and without major intracranial or spinal cord trauma were randomized to resuscitation, starting immediately after admission, to either normal values of systolic blood pressure, urine output, base deficit, hemoglobin, and cardiac index (control group, 35 patients) or optimal values (cardiac index >4.5 L/min/m2, ratio of transcutaneous oxygen tension to fractional inspired oxygen >200, oxygen delivery index >600 mL/min/m2, and oxygen consumption index >170 mL/min/m2; optimal group, 40 patients). Initial cardiac output monitoring was done noninvasively by bioimpedance and, subsequently, invasively by thermodilution. Crystalloids, colloids, blood, inotropes, and vasopressors were used by predetermined algorithms. Results: Optimal values were reached intentionally by 70% of the optimal patients and spontaneously by 40% of the control patients. There was no difference in rates of death (15% optimal vs. 11% control), organ failure, sepsis, or the length of intensive care unit or hospital stay between the two groups. Patients from both groups who achieved optimal values had better outcomes than patients who did not. The death rate was 0% among patients who achieved optimal values compared with 30% among patients who did not. Age younger than 40 years was the only independent predictive factor of the ability to reach optimal values. Conclusions: Severely injured patients who can achieve optimal hemodynamic values are more likely to survive than those who cannot, regardless of the resuscitation technique. In this study, attempts at early optimization did not improve the outcome of the examined subgroup of severely injured patients.
AB - Objective: To evaluate the effect of early optimization in the survival of severely injured patients. Summary Background Data: It is unclear whether supranormal ('optimal') hemodynamic values should serve as endpoints of resuscitation or simply as markers of the physiologic reserve of critically injured patients. The failure of optimization to produce improved survival in some randomized controlled trials may be associated with delays in starting the attempt to reach optimal goals. There are limited controlled data on trauma patients. Methods: Seventy-five consecutive severely injured patients with shock resulting from bleeding and without major intracranial or spinal cord trauma were randomized to resuscitation, starting immediately after admission, to either normal values of systolic blood pressure, urine output, base deficit, hemoglobin, and cardiac index (control group, 35 patients) or optimal values (cardiac index >4.5 L/min/m2, ratio of transcutaneous oxygen tension to fractional inspired oxygen >200, oxygen delivery index >600 mL/min/m2, and oxygen consumption index >170 mL/min/m2; optimal group, 40 patients). Initial cardiac output monitoring was done noninvasively by bioimpedance and, subsequently, invasively by thermodilution. Crystalloids, colloids, blood, inotropes, and vasopressors were used by predetermined algorithms. Results: Optimal values were reached intentionally by 70% of the optimal patients and spontaneously by 40% of the control patients. There was no difference in rates of death (15% optimal vs. 11% control), organ failure, sepsis, or the length of intensive care unit or hospital stay between the two groups. Patients from both groups who achieved optimal values had better outcomes than patients who did not. The death rate was 0% among patients who achieved optimal values compared with 30% among patients who did not. Age younger than 40 years was the only independent predictive factor of the ability to reach optimal values. Conclusions: Severely injured patients who can achieve optimal hemodynamic values are more likely to survive than those who cannot, regardless of the resuscitation technique. In this study, attempts at early optimization did not improve the outcome of the examined subgroup of severely injured patients.
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U2 - 10.1097/00000658-200009000-00013
DO - 10.1097/00000658-200009000-00013
M3 - Article
VL - 232
SP - 409
EP - 418
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
IS - 3
ER -