Severe acidosis alone does not predict mortality in the trauma patient

40. Severe acidosis alone does not predict mortality in the trauma patient 691-695 Ron Robertson, John Eidt, Lon Bitzer, Bonny Wallace, Terry Collins, Claudia Parks-Miller, John Cone Preview Purchase PDF (657 K) | Related Articles | References : Because severe acidosis is an indicator of poor prognosis in trauma patients, medical records of these patients were analyzed to determine whether aggressive resuscitation was appropriate. : Data from a level 1 trauma center registry were reviewed retrospectively to identify patients with a pH ≤7.0. Thirty-seven patients were identified. Severely acidotic patients were compared to average trauma patients in terms of demographics, resuscitation, injury, and outcome. Surviving acidotic patients were also compared to nonsurviving acidotic patients. : Half of the severely acidotic group survived initial resuscitation with approximately one third surviving to leave the hospital. There were no chronically disabled survivors. Nonsurviving acidotic patients were more unstable, more neurologically depressed, and more severely injured. Resuscitation efforts did not consume excessive hospital resources. : Severe acidosis alone is not a sufficiently powerful predictor of outcome to justify withholding resuscitation; however, when combined with coma and shock, this condition had no survivors in this small series. Article Outline • References 41. Survival in major burn injuries is predicted by early response to Swan-Ganz-Guided resuscitation 696-700 William R. Schiller, R. Curtis Bay, John G. Mclachlan, Scott G. Sagraves Preview Purchase PDF (725 K) | Related Articles | References : Two years ago the authors began to use Swan-Ganz catheters to generate more complex hemodynamic data as a better guide to resuscitation of burns. This study uses the information to identify differences between survivors and nonsurvivors. : Fifty-three consecutive patients with major burns were treated using Swan-Ganz-generated data. Additional information was collected, including demographics, intake and output, medications, and arterial blood gas (including calculated oxygen consumption). Statistical analysis incorporated adjustments for autocorrelation. : The patients included 38 men and 15 women, averaged 43.7 years of age, and had a mean burn size of 40%. Thirteen patients suffered severe inhalation injury. Data collected hourly over 3 days were collapsed across 6-hour observation periods. Mean values, when plotted across time, discriminated the 37 survivors from the 16 nonsurvivors. Poor response to resuscitation as evidenced by increased use of colloid fluid and cardiotonic drugs plus failure to maximize oxygen consumption were associated with nonsurvival. : Unsustained or inadequate response to hyperdynamic resuscitation of burns was associated with nonsurvival. Article Outline • References