Blunt Trauma Resuscitation: The Old Can Respond

• Published in: Archives of surgery (Chicago. 1960) Vol. 135; no. 6; pp. 688 - 695
• Main Authors: McKinley, Bruce A, Marvin, Robert G, Cocanour, Christine S, Marquez, Alicia, Ware, Drue N, Moore, Frederick A
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 01.06.2000
• Subjects: Adult; Aged; Case-Control Studies; Cohort Studies; Erythrocyte Transfusion; Female; Fluid Therapy; Hemodynamics - physiology; Humans; Length of Stay - statistics & numerical data; Male; Pulmonary Artery; Resuscitation - methods; Resuscitation - mortality; Wounds, Nonpenetrating - mortality; Wounds, Nonpenetrating - therapy
• ISSN: 0004-0010; 2168-6254; 1538-3644; 2168-6262
• DOI: 10.1001/archsurg.135.6.688

HYPOTHESIS Old and young trauma patients are capable of hyperdynamic response during standardized shock resuscitation. DESIGN The responses of old and young trauma patients resuscitated using a standardized protocol are compared in an inception cohort study. A standardized resuscitation protocol was used to attain and maintain an oxygen delivery index of 600 mL/min · m2 or greater (DO2 I≥600) for the first 24 hours in the intensive care unit. Interventions, responses, and outcomes for old (≥65 years) and young (<65 years) patients are described. Data were analyzed using analysis of variance, the χ2 test, and the t test; P <.05 was considered significant. SETTING A 20-bed shock trauma intensive care unit in a regional level I trauma center. PATIENTS Patients at high risk of postinjury multiple organ failure, ie, major organ or vascular injury and/or skeletal fractures, initial base deficit of 6 mEq/L or greater, need for 6 units or more of packed red blood cells in the first 12 hours, or age of 65 years or older with any 2 previous criteria. INTERVENTIONS Pulmonary artery catheter, crystalloid fluid infusion, packed red blood cell transfusion, and moderate inotrope support, as needed in that sequence, to attain DO2 I≥600. MAIN OUTCOME MEASURES Intensive care unit length of stay and survival. RESULTS During 19 months ending June 1999, 12 old patients (58% male; age, 76 ± 2 years [mean±SEM] [P <.001]; Injury Severity Score, 20 ± 2 [P =.02]) and 54 young patients (61% male; age, 37 ± 2 years; Injury Severity Score, 32 ± 2) were resuscitated. Initially, for old patients (cardiac index, 2.0 ± 0.2 L/min · m2 ) and for young patients (cardiac index, 3.0 ± 0.2 L/min · m2 ;P =.01), 24-hour volumes were as follows: 16 ± 3 L of crystalloid and 12 ± 3 units of packed red blood cells for the old patients and 21 ± 2 L of crystalloid and 19 ± 2 units of packed red blood cells for the young patients. For old patients, 9 (75%) attained DO2 I≥600, and 11 (92%) survived 7 or more days and 5 (42%) 30 or more days. For young patients, 45 (83%) attained the DO2 I goal, and 48 (89%) survived 30 or more days. Intensive care unit length of stay was 25 ± 9 days for the old patients and 23 ± 2 days for the young patients. CONCLUSIONS Elderly patients have initially depressed cardiac index but generate hyperdynamic response. Although ultimate outcome is poorer than in the younger cohort, resuscitation is not futile.Arch Surg. 2000;135:688-695 -->