Tissue ischemia microdialysis assessments following severe traumatic haemorrhagic shock: lactate/pyruvate ratio as a new resuscitation end point?

BMC Anesthesiology

Filip Burša²  Leopold Pleva¹  Jan Máca²  Peter Sklienka²  Pavel Ševčík² 

[1] Traumatology Centre, University Hospital Ostrava, Faculty of Medicine Universitas Ostrava, 17. listopadu 1790, Ostrava-Poruba, Czech Republic

[2] Department of anesthesiology and intensive care medicine, University Hospital Ostrava, Faculty of Medicine Universitas Ostrava, 17. listopadu 1790, Ostrava-Poruba, Czech Republic

关键词: Trauma;    Transfusion;    Cardiac output;    Haemoglobin;    Pyruvate;    Lactate;    Shock;    Microdialysis;   

Others  :  1084212
DOI  :  10.1186/1471-2253-14-118

 received in 2014-09-01, accepted in 2014-12-10,  发布年份 2014

【 摘 要 】

Background

Intensive care of severe trauma patients focuses on the treatment of haemorrhagic shock. Tissues should be perfused sufficiently with blood and with sufficient oxygen content to ensure adequate tissue oxygen delivery. Tissue metabolism can be monitored by microdialysis, and the lactate/pyruvate ratio (LPR) may be used as a tissue ischemia marker. The aim of this study was to determine the adequate cardiac output and haemoglobin levels that avoid tissue ischemia.

Methods

Adult patients with serious traumatic haemorrhagic shock were enrolled in this prospective observational study. The primary observed parameters included haemoglobin, cardiac output, central venous saturation, arterial lactate and the tissue lactate/pyruvate ratio.

Results

Forty-eight patients were analysed. The average age of the patients was 39.8 ± 16.7, and the average ISS was 43.4 ± 12.2. Hb < 70 g/l was associated with pathologic arterial lactate, ScvO₂ and LPR. Tissue ischemia (i.e., LPR over 25) developed when CI ≤ 3.2 l/min/m² and Hb between 70 and 90 g/l were observed. Severe tissue ischemia events were recorded when the Hb dropped below 70 g/l and CI was 3.2-4.8 l/min/m². CI ≥ 4.8 l/min/m² was not found to be connected with tissue ischemia, even when Hb ≤ 70 g/l.

Conclusion

LPR could be a useful marker to manage traumatic haemorrhagic shock therapies. In initial traumatic haemorrhagic shock treatments, it may be better to maintain CI ≥ 3.2 l/min/m² and Hb ≥ 70 g/l to avoid tissue ischemia. LPR could also be a useful transfusion trigger when it may demonstrate ischemia onset due to low local DO₂ and early reveal low/no tissue perfusion.

【 授权许可】

   
2014 Burša et al.; licensee BioMed Central.

【 图 表 】

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