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2022, Number 1

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Revista Cubana de Cirugía 2022; 61 (1)

Base Deficit, Lactate and Shock Index as Mortality Predictors in Trauma Patients

Labrada DA, Bárcenas CMC, Rodríguez AG

Language: Spanish
References: 37
Page: 1-17
PDF size: 475.82 Kb.


ABSTRACT

Introduction: Physiological responses to hemorrhage, such as hypotension and tachycardia, are not always proportional to the state of shock, which has led to the need to use other predictors.
Objective: To analyze the characteristics of base deficit, lactate and severe shock index as predictors of mortality in multiply injured patients.
Methods: An analytical, observational and retrospective study was carried out in the anesthesiology and resuscitation service of General Calixto García University Hospital, between August 2018 and August 2020. The sample was made up of 50 patients, according to nonprobabilistic selection criteria of the researcher.
Results: Patients who suffered cranial trauma were seven times more likely to die. The index of severe shock at three hours tripled the risk of death. Lactate and baseline deficit correlated significantly with shock index greater than one. Blood transfusion doubled the risk of death, while amine requirements were not shown to be poor prognostic factors. Among complications, systemic inflammatory response was shown to have nine times higher risk of dying and multiple organ dysfunction seven times, but the presence of pneumonia did not influence death.
Conclusions: The severe shock index was considered a prognostic factor for mortality in polytraumatized patients, as far as it tripled the risk of dying and was related to elevated lactate and altered base deficit values.


REFERENCES

  1. Organización Mundial de la Salud. Las 10 principales causas de defunción. Ginebra: OMS. 2017 [acceso 16/04/2020]. Disponible en: Disponible en: https://www.who.int/es/news-room/factsheets/detail/the-top-10-causes-of-death

  2. National Institute for Health and Care Excellence. Major trauma: assessment and initial management. Guideline NG39. Reino Unido. 2016 [acceso 21/05/2020];35(4):[aprox. 7 p.]. Disponible en: Disponible en: https://www.nice.org.uk/guidance/ng39

  3. Castillo Payamps RA, Escalona Cartaya JA, Pérez Acosta JR, Rodríguez Fernández Z. Caracterización de los pacientes con traumatismos graves ingresados en un servicio de Cirugía General. MEDISAN. 2016 [acceso 10/12/2020];20(1):16-27. Disponible en: Disponible en: http://medisan.sld.cu/index.php/san/article/view/642

  4. Félix-Sifuentes DJ. Shock hipovolémico, un nuevo enfoque de manejo. Rev Mex Anest. 2018 [acceso 05/06/2020];41(S1):169-174. Disponible en: Disponible en: https://www.medigraphic.com/pdfs/rma/cma-2018/cmas181be.pdf

  5. Cannon JW. Hemorrhagic shock. N Engl J Med. 2018;378(4):370-9. DOI: https://doi.org/10.1056/NEJMra1705649

  6. Casado Méndez PR, Ricardo Martínez D, Santos Fonseca RS, Gallardo Arzuaga RL, Pérez Súarez MJ. Evaluación de índices pronósticos en el trauma abdominal cerrado. Rev Cub Cir. 2019 [acceso 21/01/2021];58(4):e857. Disponible en: Disponible en: http://www.revcirugia.sld.cu/index.php/cir/article/view/857

  7. McKinley TO, McCarroll T, Metzger C, Zarzaur BL, Savage SA, Bell T, et al. Shock volume: patient-specific cumulative hypoperfusion predicts organ dysfunction in a prospective cohort of multiply injured patients. J Trauma Acute Care Surg. 2018;85(1):S84-S91. DOI: https://doi.org/10.1097/TA.0000000000001871

  8. Pitotti C, David J. An Evidence-Based Approach to Nonoperative Management of Traumatic Hemorrhagic Shock in the Emergency Department. Emergency Medicine Practice. 2020 [acceso 21/12/2020];22(11):1-24. Disponible en: Disponible en: https://www.ebmedicine.net/topics/hematologic/hemorrhagic-shock/pearls

  9. Pacagnella RC, Souza JP, Durocher J, Perel P, Blum J, Winikoff B, et al. A systematic review of the relationship between blood loss and clinical signs. PLoS One. 2013;8(3):e57594. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0057594

  10. Rau CS, Wu SC, Kuo SCH, Pao-Jen K, Shiun-Yuan H, Chen YC, et al. Prediction of massive transfusión in trauma patients with shock index, modified shock index, and age shock index. Int J Environ Res Public Health. 2016;13(7). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962224/pdf/ijerph-13-00683.pdf

  11. Mutschler A, Nienaber U, Brockamp T, Wafaisade A, Wyen H, Peiniger S, et al. A critical reappraisal of the ATLS classification of hypovolemic shock: does it really reflect clinical reality? Resuscitation. 2013,84:309-313 DOI: https://doi.org/10.1016/j.resuscitation.2012.07.012

  12. Montoya KF, Charry JD, Calle Toro JS, Ramiro Nuñez L, Poveda G. Shock index as a mortality predictor in patients with acute polytrauma. Journal of Acute Disease. 2015 [acceso 05/06/2020];4(3):202-4. Disponible en: Disponible en: https://www.sciencedirect.com/science/article/pii/S222161891500030X

  13. Ordonez CA, Orozco V, Puyana JC, Parra M, Ossa P, Escobar SS, et al. Índice de Shock: ¿Puede predecir la necesidad de cirugía de control de daños en trauma penetrante? Panam J Trauma Crit Care Emerg Surg. 2017 [acceso 05/09/2020];6(2):72-6 Disponible en: Disponible en: https://www.pajtcces.com/doi/PAJT/pdf/10.5005/jp-journals-10030-1176

  14. Schellenberg M, Strumwasser A, Grabo D, Clark D, Matsushima K, Inaba K, et al. Delta shock index in the emergency department predicts mortality and need for blood transfusion in trauma patients. Am Surg. 2017;83(10):1059-62. DOI: https://doi.org/10.1177/000313481708301009

  15. Caputo N, Reilly J, Kanter M, West J. A retrospective analysis of the respiratory adjusted shock index to determine the presence of occult shock in trauma patients. J Trauma Acute Care Surg. 2018;84(4):674-8. DOI: https://doi.org/10.1097/TA.0000000000001761

  16. Duarte Mote J, Lee-Eng Castro V, Romero Figueroa S, Aguilar Hidalgo JA, Gómez Hernández GL, Sánchez Rojas G. Lactato ¿marcador de hipoperfusión? Med Int Méx. 2019;35(6):934-43. DOI: https://doi.org/10.24245/mim.v35i6.3173

  17. Laverde Sabogal CE, Correa Rivera AF, Joya Higuera AY. Lactato y déficit de bases en trauma: valor pronóstico. Rev Colomb Anestesiol. 2014;42(1):60-4. DOI: https://doi.org/10.1016/j.rca.2013.09.002

  18. Raux M, Le Manach Y, Gauss T, Baumgarten R, Hamada S, Harrois A, et al. Comparison of the prognostic significance of initial blood lactate and base deficit in trauma patients. Anesthesiology. 2017;126(3):522-33. DOI: https://doi.org/10.1097/ALN.0000000000001490

  19. Sánchez D, Lara B, Clausdorff H, Guzmán A. Generalidades y manejo inicial del shock. Revista de Ciencias Médicas. 2019;44(1):66-76. DOI: http://dx.doi.org/10.11565/arsmed.v44i1.1375

  20. Tjardes T, Luecking M. The Platinum 5 min in TCCC: Analysis of junctional and extremity hemorrhage scenarios with a mathematical model. Mil Med. 2018;183(5-6):e207-e215. DOI: https://doi.org/10.1093/milmed/usx016

  21. Dammers D, El Moumni M, Hoogland II, Veeger N, Ter Avest E. Should we perform a FAST exam in haemodynamically stable patients presenting after blunt abdominal injury: a retrospective cohort study. Scand J Trauma Resusc Emerg Med. 2017;25(1):1-7. DOI: https://doi.org/10.1186/s13049-016-0342-0

  22. Fernández Díaz M, Martínez Valenzuela N, Martínez Hernández JA, Pierre Marzo R. Comportamiento del lesionado en el Hospital Universitario “General Calixto García” Rev Cub Cir. 2021 [acceso 28/09/2020];60(1):e_1033. Disponible en: Disponible en: http://www.revcirugia.sld.cu/index.php/cir/article/view/1033

  23. Martínez Alvarado MV, Pérez de León ER. El traumatizado grave en la Unidad de Cuidados Intensivos. Comportamiento en el H.M.C. “Dr. Carlos J. Finlay”. Rev Cub Med Int Emerg 2007; 6(3):824-34. Disponible en: http://bvs.sld.cu/revistas/mie/vol6_3_07/mie05307.pdf

  24. Sharma OP, Oswanski MF, Sharma V, Stringfellow K, Raj SS. An appraisal of trauma in the elderly. Am Surg. 2007 [acceso 05/10/2020];73(4):354-8. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/17439028

  25. Olaussen A, Blackburn T, Mitra B, Fitzgerald M. Review article: Shock Index for prediction of critical bleeding post-trauma: A systematic review. Emerg Med Australas. 2014;26(3):223-8. DOI: https://doi.org/10.1111/1742-6723.12232

  26. Charry JD, Bermeo JM, Montoya KF, Calle TJ, Ramiro NL, Poveda G. Índice de shock como factor predictor de mortalidad en el paciente con trauma penetrante de tórax. Rev Colomb Cir. 2015 [acceso 08/09/2020];30(1):24-8. Disponible en: Disponible en: www.scielo.org.co/pdf/rcci/v30n1/v30n1a4.pdf

  27. McNab A, Burns B, Bhullar I, Chesire D, Kerwin A. A prehospital shock index for trauma correlates with measures of hospital resource use and mortality. Surgery. 2012;152(3):473-6. DOI: https://doi.org/10.1016/j.surg.2012.07.010

  28. Ibrahim I, Chor WP, Chue KM, Tan CS, Tan HL, Siddiqui FJ, et al. Is arterial base deficit still a useful prognostic marker in trauma? A systematic review. Am J Emerg Med. 2016;34(3):626-35. DOI: https://doi.org/10.1016/j.ajem.2015.12.012

  29. Mutschler M, Nienaber U, Brockamp T, Wafaisade A, Fabian T, Paffrath T, et al. Renaissance of base deficit for the initial assessment of trauma patients: a base deficit-based classification for hypovolemic shock developed on data from 16,305 patients derived from the TraumaRegister DGU®. Crit Care. 2013;17(2):R42. DOI: https://doi.org/10.1186/cc12555

  30. Shackelford SA, Del Junco DJ, Powell-Dunford N, Mazuchowski ED, Howard JT, Kotwal RS, et al. Association of prehospital blood product transfusion during medical evacuation of combat casualties in afghanistan with acute and 30-day survival. JAMA. 2017;318(16):1581-91. DOI: https://doi.org/10.1001/jama.2017.15097

  31. Labrada Despaigne A, Rodríguez DL, Martínez Clavel L. Factores de riesgo de mortalidad en pacientes politraumatizados. Rev Cub Anestesiol Reanimac. 2018 [acceso 21/01/2021];17(3):1-13. Disponible en: Disponible en: http://www.revanestesia.sld.cu/index.php/anestRean/article/view/512/731

  32. Mitra B, Fitzgerald M, Chan J. The utility of a shock index ≥ 1 as an indication for pre-hospital oxygen carrier administration in major trauma. Injury. 2014;45(1):61-5. DOI: https://doi.org/10.1016/j.injury.2013.01.010

  33. Mitra B, Olaussen A, Cameron PA, O'Donohoe T, Fitzgerald M. Massive blood transfusions post trauma in the elderly compared to younger patients. Injury. 2014;45(9):1296-300. DOI: https://doi.org/10.1016/j.injury.2014.01.016

  34. Gupta B, Garg N, Ramachandran R. Vasopressors: Do they have any role in hemorrhagic shock? J Anaesthesiol Clin Pharmacol. 2017;33(1):3-8. DOI: https://doi.org/10.4103/0970-9185.202185

  35. Huang GS, Dunham CM. Mortality outcomes in trauma patients undergoing prehospital red blood cell transfusion: a systematic literature review. Int J Burns Trauma. 2017 [acceso 05/10/2020];7(2):17-26. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/28533934/

  36. Pérez Assef A, Cid Rodríguez F, Gómez Plasencia RF, Naranjo Igarza S, Calixto Augier D. Comportamiento y pronóstico del síndrome de disfunción múltiple de órganos. Mapfre Medicina. 2002 [acceso 05/10/2020];13(3):165-9. Disponible en: Disponible en: https://sid.usal.es/idocs/F8/ART8644/organos.pdf

  37. Tian LH, Gao W, Hu D, Zhao H, Yi CL. Value of monitoring oxygen metabolism in multiple organ dysfunction syndrome after severe trauma. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2007 [acceso 05/10/2020];19(1):21-4. Disponible en: Disponible en: https://pubmed.ncbi.nlm.nih.gov/17207359/




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