Hemodynamic effects of kinetic therapy in critically ill trauma patients
© BioMed Central Ltd 2001
Published: 1 March 1997
Background and objectives
The application of the pulmonary artery catheter (PAC) has been well established in the treatment of haemodynamic unstable patients in the last 20 years. A new variation of the PAC is available now. These systems use the thermodilution with heat for the calculation of the cardiac output and are able to generate out of these data a continuous cardiac output curve. The computed data which can be visualised on a monitor, provide the surgeon with an 'on-line' monitoring of this important haemodynamic parameter. The fluid and drug management of the polytrauma patient in the initial trauma phases could be one of the fields in ICU therapy where by this new device may be beneficial.
To evaluate the diagnostic and therapeutic impact of the continuous cardiac output (CCO) measurement for the haemodynamic unstable polytrauma patient we initiated a prospective pilot study. The Baxter Vigilance System was used for measuring the continuous cardiac output. Patients were scored on the first day for Injury Severity Score (ISS) and APACHE II. The CCO was used no later than 5 h after the initial treatment in 10 polytrauma patients. The CCO values were controlled three times a day by the conventional 'cold' thermodilution technique. Continuous SVO2 measurement was carried out in addition. As outcome parameters were chosen days on ventilation, days on the ICU and days in hospital. The results were compared with the same parameters evaluated of 50 polytrauma patients who were not treated by the CCO method on the same ICU unit. The treating ICU physicians were asked in a standardised questionnaire whether or not there was an impact of the CCO measurement on their therapy.
Group I represents the CCO patients (n = 10), group II the control group without CCO monitoring (n = 50). The mean age of group I was 42 years, of group II, 29 years. Mean ISS: group I, 50; group II, 38. Mean APACHE II: group I, 17.5; group II, 14. Mean days on ventilation: group I, 10; group II, 7. Mean days on ICU: group I, 18; group II, 8.5. Mean time in hospital (days): group I, 24: group II, 19.5. In group I, two patients (20%), in group II, six patients (12%) died during their stay in hospital. The catheter was in use for a mean time of 3 days (2–20). Seven different surgeons were working with the system. The unique opinion was that the CCO device had a significant impact on their decision making in the fluid or drug management of the study patients.
Even regarding the greater severity of illness in group I it is still too early to state that the use of the CCO measurement can reduce the mortality in polytrauma patients. Our first experience, however, suggests that these devices may become an important improvement in the management of haemodynamics in the early trauma phases. We are now working out a more extensive prospective study to prove the assumption.