Vasopressor use following traumatic injury - A single center retrospective study

被引:1
|
作者
Hylands, Mathieu [1 ]
Godbout, Marie-Pier [1 ]
Mayer, Sandeep K. [1 ]
Fraser, William D. [2 ,3 ]
Vanasse, Alain [2 ,4 ]
Leclair, Marc-Andre [5 ]
Turgeon, Alexis F. [6 ,7 ]
Lauzier, Francois [7 ,8 ]
Charbonney, Emmanuel [9 ,10 ]
Trottier, Vincent [7 ,11 ]
Razek, Tarek S. [12 ]
Roy, Andre [13 ,14 ]
D'Aragon, Frederick [2 ,15 ]
Belley-Cote, Emilie [2 ,5 ]
Day, Andrew G. [16 ]
Le Guillan, Soazig [17 ]
Sabbagh, Robert [2 ,18 ]
Lamontagne, Francois [2 ,5 ]
机构
[1] Univ Sherbrooke, Div Gen Surg, Sherbrooke, PQ, Canada
[2] Univ Sherbrooke, Ctr hosp, Ctr Rech, Sherbrooke, PQ, Canada
[3] Univ Sherbrooke, Dept Obstet & Gynecol, Sherbrooke, PQ, Canada
[4] Univ Sherbrooke, Dept Family Med & Emergency Med, Sherbrooke, PQ, Canada
[5] Univ Sherbrooke, Dept Med, Sherbrooke, PQ, Canada
[6] Univ Laval, Dept Anesthesia & Crit Care, Quebec City, PQ, Canada
[7] Univ Quebec, Ctr hosp, Ctr Rech, Quebec City, PQ, Canada
[8] Univ Laval, Dept Med, Quebec City, PQ, Canada
[9] Univ Montreal, Dept Crit Care, Montreal, PQ, Canada
[10] Hop Sacre Coeur, Ctr Rech, Montreal, PQ, Canada
[11] Univ Laval, Dept Gen Surg, Quebec City, PQ, Canada
[12] MUHC Montreal Gen Hosp, Dept Gen Surg, Dept Trauma Surg, Montreal, PQ, Canada
[13] Univ Montreal, Dept Physiatry, Montreal, PQ, Canada
[14] Univ Montreal, Ctr Hosp, Ctr Rech, Montreal, PQ, Canada
[15] Univ Sherbrooke, Dept Anesthesiol, Sherbrooke, PQ, Canada
[16] Queens Univ, Dept Community Hlth & Epidemiol, Kingston, ON, Canada
[17] Sacre Coeur Hosp Montreal, Div Traumatol, Div Gen Surg, Montreal, PQ, Canada
[18] Univ Sherbrooke, Dept Urol, Sherbrooke, PQ, Canada
来源
PLOS ONE | 2017年 / 12卷 / 04期
关键词
HYPOTENSIVE RESUSCITATION; EMERGENCY-DEPARTMENT; FLUID RESUSCITATION; HEMORRHAGIC-SHOCK; MULTIPLE TRAUMA; BRAIN-INJURY; COAGULOPATHY; SYSTEM; IMPACT; INDEX;
D O I
10.1371/journal.pone.0176587
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Objectives Vasopressors are not recommended by current trauma guidelines, but recent reports indicate that they are commonly used. We aimed to describe the early hemodynamic management of trauma patients outside densely populated urban centers. Methods We conducted a single-center retrospective cohort study in a Canadian regional trauma center. All adult patients treated for traumatic injury in 2013 who died within 24 hours of admission or were transferred to the intensive care unit were included. A systolic blood pressure < 90 mmHg, a mean arterial pressure < 60 mmHg, the use of vasopressors or >= 2 L of intravenous fluids defined hemodynamic instability. Main outcome measures were use of intravenous fluids and vasopressors prior to surgical or endovascular management. Results Of 111 eligible patients, 63 met our criteria for hemodynamic instability. Of these, 60 (95%) had sustained blunt injury and 22 (35%) had concomitant severe traumatic brain injury. The subgroup of patients referred from a primary or secondary hospital (20 of 63, 32%) had significantly longer transport times (243 vs. 61 min, p < 0.01). Vasopressors, used in 26 patients (41%), were independently associated with severe traumatic brain injury (odds ratio 10.2, 95% CI 2.7-38.5). Conclusions In this cohort, most trauma patients had suffered multiple blunt injuries. Patients were likely to receive vasopressors during the early phase of trauma care, particularly if they exhibited signs of neurologic injury. While these results may be context-specific, determining the risk-benefit trade-offs of fluid resuscitation, vasopressors and permissive hypotension in specific patients subgroups constitutes a priority for trauma research going forwards.
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页数:12
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