Need for cardiac output monitoring in elderly trauma patients determined by base deficit

Introduction

Elderly patients tolerate trauma less well than younger patients. Early monitoring of the cardiac output to improve peripheral perfusion can diminish mortality and complications in elderly patients. Base deficit can be used as a marker of significant injury and to predict resource utilization and mortality. The purpose of this study is to determine which patients will require intervention.

Method

Our Trauma Service has established a trauma in the elderly protocol. Criteria for activation includes patients 60 years or older, multisystem injuries or single system injuries with significant co-morbid factors. Patients meeting criteria are transferred to the intensive care unit and placed on cardiac output monitoring. Intervention consisting of packed red blood cells, vasopressors and/or inotropes is indicated if the cardiac index is less than 3 l/min/m² or the patient has an abnormal base deficit.

Results

From April 1995 to July 2000, 76 patients met criteria. The patients were divided into three Groups according to their initial base deficit: Group I normal base deficit, 3 to –2, Group II moderate base deficit –2.1 to –6, Group III severe base deficit –6.1 or greater. The results are summarized in the Table.

Table

Group I patients required significantly less intervention to improve cardiac output than Group II and Group III, 15% versus 42% and 94% respectively, P < 0.05. Overall, 22 patients (29%) expired, 31 (41%) were discharged home and 23 (30%) to an extended care facility.

Conclusions

Base deficit can be used to determine which patients are most likely to require intervention. Elderly trauma patients with normal base deficit on admission seldom require cardiac output monitoring. Elderly patients with severe base deficit have a high mortality.