Introduction
Materials and methods
Participants
Protocol
Assessments
Statistical analysis
Results
Characteristics | Doppler group | Control group |
---|---|---|
Number in group | 80 | 82 |
Age in years | 33 (26–57) | 40 (26–50) |
Male | 73 (91%) | 70 (85%) |
APACHE II | 20 (16–21) | 18 (12–23) |
Injury Severity Score | 38.5 ± 10.5 | 36.4 ± 11.8 |
SOFA score at ICU admission | 8 (7–10) | 8 (6–11) |
Type of injury | ||
Chest | 42 (52%) | 50 (61%) |
Abdomen | 52 (65%) | 48 (58%) |
Spine | 24 (30%) | 21 (26%) |
Pelvis | 36 (45%) | 43 (52%) |
Extremities | 76 (95%) | 76 (93%) |
Parameters | Doppler group (n = 80) | Control group (n = 82) |
p
|
---|---|---|---|
Mean arterial pressure (mm Hg) | 65 (60–71) | 65 (55–75) | 0.71 |
Central venous pressure (mm Hg) | 7.1 ± 2.1 | 6.8 ± 2.1 | 0.34 |
Lactate (mmol/l) | 4.2 (3.2–5.2) | 3.9 (3.0–4.7) | 0.08 |
Intervention | |||
Norepinephrine (patients) | 58 (73%) | 57 (70%) | 0.73 |
Norepinephrine (μg/kg per minute) | 0.23 (0.14–0.60) | 0.21 (0.12–0.41) | 0.25 |
Parameters | Doppler group (n = 80) | Control group (n = 82) |
p
|
---|---|---|---|
Mean arterial pressure (mm Hg) | 78 ± 6.5 | 79 ± 9.5 | 0.76 |
Central venous pressure (mm Hg) | 13.7 ± 1.8 | 12.1 ± 2.4 | < 0.0001 |
Lactate (mmol/l) | 2.92 ± 0.54 | 3.23 ± 0.54 | 0.0003 |
Intervention | |||
Colloid (ml) | 1,667 ± 426 | 682 ± 322 | < 0.0001 |
Crystalloid (ml) | 1,293 ± 300 | 1,334 ± 320 | 0.38 |
Blood (ml) | 814 ± 228 | 833 ± 340 | 0.67 |
Fresh frozen plasma (ml) | 742 (566–949) | 750 (562–1,108) | 0.69 |
Norepinephrine (patients) | 18 (23%) | 33 (40%) | 0.018 |
Norepinephrine (μg/kg per minute) | 0.093 ± 0.035 | 0.169 ± 0.068 | 0.0009 |
Parameters | Doppler group (n = 80) | Control group (n = 82) |
p
|
---|---|---|---|
Lactate after 24 hours of ICU stay (mmol/l) | 1.99 ± 0.44 | 2.37 ± 0.59 | < 0.0001 |
The highest SOFA during ICU stay | 10 (7–12.75) | 11 (7–14) | 0.17 |
Infectious complication | |||
Pneumonia | 10 | 19 | 0.09 |
Central venous catheter | 5 | 6 | 1.00 |
Abdominal | 2 | 4 | 0.68 |
Urinary tract | 3 | 2 | 1.00 |
Wound | 2 | 5 | 0.44 |
Total infectious complications | 22 | 36 | 0.033 |
Patients with infectious complications | 15 (18.8%) | 28 (34.1%) | 0.032 |
Length of ICU stay in days | 7 (6–11) | 8.5 (6–16) | 0.031 |
Length of hospital stay in days | 14 (8.25–21) | 17.5 (11–29) | 0.045 |
ICU mortality | 11 (13.8%) | 16 (19.5%) | 0.40 |
Hospital mortality | 13 (16.3%) | 18 (22%) | 0.43 |
Discussion
Conclusion
Key messages
-
Optimization of intravascular volume using esophageal Doppler in multiple-trauma patients decreases blood lactate levels.
-
Fluid resuscitation in multiple-trauma patients guided by esophageal Doppler is associated with a lower incidence of infectious complications and reduces ICU and hospital stays.