Anesthesiologie - Urgentiegeneeskunde
  • Home
  • Updates
    • Nieuws
    • Artikel van de week
    • Tip van de week
    • Congres tips & reviews
    • Cursus Tips & Reviews
  • D-examen
  • Online Lectures
    • Resuscitation
    • Trauma
    • Airway Management
    • Prehospital Emergency Medicine
    • Crew Resource Management
    • ResusNL
  • Educatie
    • Apps
    • Podcasts
    • Blogs & Sites
    • Boeken
    • Congressen
    • Cursussen
  • Over ons

Renaissance of base deficit for the initial assessment of trauma patients: a base deficit- based classification for hypovolemic shock developed on data from 16,305 patients derived from the TraumaRegister DGU®

6/16/2014

0 Comments

 

Critical Care 2013, 17:R42 

Manuel Mutschler1,2*, Ulrike Nienaber3, Thomas Brockamp1, Arasch Wafaisade1, Tobias Fabian1, Thomas Paffrath1, Bertil Bouillon1, Marc Maegele1 and the TraumaRegister DGU4 

Introduction: The recognition and management of hypovolemic shock still remain an important task during initial trauma assessment. Recently, we have questioned the validity of the Advanced Trauma Life Support (ATLS) classification of hypovolemic shock by demonstrating that the suggested combination of heart rate, systolic blood pressure and Glasgow Coma Scale displays substantial deficits in reflecting clinical reality. The aim of this study was to introduce and validate a new classification of hypovolemic shock based upon base deficit (BD) at emergency department (ED) arrival.
Methods: Between 2002 and 2010, 16,305 patients were retrieved from the TraumaRegister DGU® database, classified into four strata of worsening BD [class I (BD ≤ 2 mmol/l), class II (BD > 2.0 to 6.0 mmol/l), class III (BD > 6.0 to 10 mmol/l) and class IV (BD > 10 mmol/l)] and assessed for demographics, injury characteristics, transfusion requirements and fluid resuscitation. This new BD-based classification was validated to the current ATLS classification of hypovolemic shock.

Results: With worsening of BD, injury severity score (ISS) increased in a step-wise pattern from 19.1 (± 11.9) in class I to 36.7 (± 17.6) in class IV, while mortality increased in parallel from 7.4% to 51.5%. Decreasing hemoglobin and prothrombin ratios as well as the amount of transfusions and fluid resuscitation paralleled the increasing frequency of hypovolemic shock within the four classes. The number of blood units transfused increased from 1.5 (± 5.9) in class I patients to 20.3 (± 27.3) in class IV patients. Massive transfusion rates increased from 5% in class I to 52% in class IV. The new introduced BD-based classification of hypovolemic shock discriminated transfusion requirements, massive transfusion and mortality rates significantly better compared to the conventional ATLS classification of hypovolemic shock (p < 0.001).

Conclusions: BD may be superior to the current ATLS classification of hypovolemic shock in identifying the presence of hypovolemic shock and in risk stratifying patients in need of early blood product transfusion.

Mutschler et al. Critical Care 2013, 17:R42 http://ccforum.com/content/17/2/R42
See related commentary by Privette et al., http://ccforum.com/content/17/2/124 
Link naar de PDF
0 Comments



Leave a Reply.

    Categories

    All
    Airway Management
    Analgesia
    Bleeding
    Bloedverlies
    Brandwonden
    Cardiac Arrest
    Checklist
    CICO
    Coagulopathy
    CPR
    Cricothyrodotomy
    CRM
    Disaster Medicine
    Drugs
    ECLS
    ECMO
    ECPR
    Emergency Anesthesia
    Guideline
    Human Factors
    Hypotension
    Intubation
    Ketamine
    Military Trauma
    MTP
    Multidisciplinary
    OHCA
    Outcome
    Pediatric Resuscitation
    PHEM
    POCUS
    Prehospital
    Procedural Sedation
    Propofol
    Rapid Sequence Induction
    RCT
    Resuscitation
    Sedation
    Shock
    TBI
    Therapeutic Hypothermia
    Tranexaminezuur
    Transfusie
    Trauma
    Trauma Anesthesia
    Traumatic Brain Injury
    Trial
    TXA
    Ultrasound
    Video Laryngoscopy

    Archives

    October 2021
    August 2020
    November 2019
    October 2019
    August 2019
    January 2019
    August 2018
    July 2018
    January 2018
    December 2017
    October 2017
    September 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    September 2014
    June 2014

    RSS Feed

Anesthesiologie - Urgentiegeneeskunde
www.urgentiegeneeskunde.com



de gratis online resource over trauma-anesthesie, reanimatie, resuscitatie, airway management, prehospitale zorg en alles wat te maken heeft met de zorg voor de vitaal bedreigde patient.