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Global end-diastolic volume as a predictor of the need for massive transfusion in multiple-trauma patients with hemorrhagic shock
Critical Care volume 13, Article number: P212 (2009)
The PiCCO system enables hemodynamic evaluation and monitoring by two different approaches: the transpulmonary thermal dilution technique and pulse counter analysis. Optimal monitoring of cardiac preload is of paramount importance for the hemodynamic management of multiple-trauma patients with hemorrhagic shock. There have been only a few studies on the use of the PiCCO system (Pulsion, Germany) in multiple-trauma patients with hemorrhagic shock for hemodynamic monitoring. We hypothesized that performing a cardiac adequate preload evaluation with the PiCCO system would make it possible to predict latent hemorrhagic progress.
Data from 53 consecutive multiple-trauma patients (age 51 ± 17.8 years, injury severity score 30 ± 12.9) with hemorrhagic shock at the scene of the injury or in the emergency room between June 2007 and November 2008 were analyzed. All patients underwent a hemodynamic evaluation with the PiCCO system. We divided the patients into two groups according to whether they received a massive transfusion (MT) (>2,000 ml packed red blood cell transfusion after admission within 24 hours) and compared their PiCCO data: cardiac output (CO), systemic vascular resistance (SVR), indexed global end-diastolic volume (GEDVi), and indexed extravascular lung water on admission to the ICU. The chi-square test and paired t test were used to perform the statistical analysis.
Twenty-seven patients required massive transfusion. Mortality was higher in the MT group (P = 0.05), and the CO, GEDVi and ITBVi values were significantly lower in the MT group (Table 1).
The parameters measured with the PiCCO system enabled evaluation of the correct cardiac preload in the multiple-trauma patients with hemorrhagic shock. GEDVi was useful as a predictor of the need for MT.
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Saito, N., Sakamoto, Y. & Mashiko, K. Global end-diastolic volume as a predictor of the need for massive transfusion in multiple-trauma patients with hemorrhagic shock. Crit Care 13, P212 (2009). https://doi.org/10.1186/cc7376
- Injury Severity Score
- Hemorrhagic Shock
- Massive Transfusion
- Extravascular Lung Water
- Cardiac Preload