Influence of blood hemodynamics on the treatment outcomes of limited fluid resuscitation in emergency patients with traumatic hemorrhagic shock

Ke, Wen; Zhang, Linghong

doi:10.1016/j.clinsp.2023.100308

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original articles • Clinics 78 • 2023 • https://doi.org/10.1016/j.clinsp.2023.100308 copy

Influence of blood hemodynamics on the treatment outcomes of limited fluid resuscitation in emergency patients with traumatic hemorrhagic shock

Authorship SCIMAGO INSTITUTIONS RANKINGS

Highlights

LFR can improve blood hemodynamics parameters after traumatic hemorrhagic shock.
LFR would influence serum inflammatory levels after traumatic hemorrhagic shock.
Medium MAP can be employed as the optimal administrating strategy for LFR.

Abstract

Objectives

Traumatic hemorrhagic shock is a major death-related factor contributing to mortality in emergencies and can be effectively handled by the Limited Fluid Resuscitation (LFR) method. In the current investigation, the authors analyzed the influence of different administrating blood pressure on the treatment outcomes of LFR.

Methods

276 participants were enrolled in the current study retrospectively from January 2016 to December 2021 and were divided into three groups based on the administrating blood pressure of LFR. The difference among the three groups regarding serum levels of cytokines as well as blood hemodynamics parameters was analyzed.

Results

The results showed after the T2 stage treatment, cytokine levels in the three groups were all significantly influenced by different LFR strategies with medium MAP showing the strongest effects on the expression of all cytokine genes. Moreover, the MAP value was in positive correlation with IL-6, IL-10, and TNF-α levels, but showed no clear relation with IL-4 level in all three groups. Regarding the effects on hemodynamics parameters, the levels of CVP, CO, and CI were slightly increased by the different LFR administrating strategies, and the effect of medium and high MAP was statistically stronger than that of low MAP.

Conclusion

The present results showed that LFR would influence serum inflammatory levels by improving blood hemodynamics parameters. Medium MAP showed the strongest improving effects with the least side effects, which can be employed as the optimal administrating strategy for LFR in the future.

Keywords
Cytokine; Hemodynamics parameters; Limited fluid resuscitation; Mean arterial pressure; Traumatic hemorrhagic shock

	Low MAP	Medium MAP	High MAP	p-value
N	59	133	84
Body weight (kg)	61.13 ± 11.22	63.15 ± 8.96	60.11 ± 12.31	p>0.05
Age (year)	37.86 ± 5.92	34.23 ± 8.77	35.23 ± 10.34	p>0.05
Male (%)	39 (66%)	86 (65%)	64 (76%)	p>0.05
Body Temp	34.83 ± 0.66	35.12 ± 0.49	35.02 ± 0.44	p>0.05
Respiratory rate/min	26.31 ± 2.21	25.51 ± 2.91	26.13 ± 1.69	p>0.05
Heart rate/min	130.5 ± 15.22	131.5 ± 10.43	134.2 ± 11.81	p>0.05
SBP (mmHg)	69.90 ± 7.66	71.33 ± 5.76	73.13 ± 6.83	p>0.05
DBP (mmHg)	46.47 ± 4.43	43.90 ± 4.42	45.03 ± 4.68	p>0.05
MAP (mmHg)	53.54 ± 3.51	52.81 ± 3.53	54.26 ± 3.67	p>0.05
ISS	27.83 ± 3.05	28.97 ± 2.67	28.37 ± 3.45	p>0.05

			Cytokine expression level
Group	N	Stage	IL-4	IL-10	IL-6	TNF-α
Low MAP	59	T0	0.68 ± 0.23	0.54 ± 0.29	0.23 ± 0.11	0.26 ± 0.19
		T1	0.88 ± 0.37^a a p < 0.05 vs. t0 stage.	0.76 ± 0.21^a a p < 0.05 vs. t0 stage.	0.76 ± 0.39^a a p < 0.05 vs. t0 stage.	0.42 ± 0.20^a a p < 0.05 vs. t0 stage.
		T2	1.17 ± 0.48^a a p < 0.05 vs. t0 stage.	0.91 ± 0.38^a a p < 0.05 vs. t0 stage.	1.26 ± 0.43^a a p < 0.05 vs. t0 stage. ,^b b p < 0.05 vs. t1 stage.	0.95 ± 0.44^a a p < 0.05 vs. t0 stage. ^b b p < 0.05 vs. t1 stage.
		T0	0.71 ± 0.22	0.49 ± 0.18	0.28 ± 0.24	0.29 ± 0.11
Medium MAP	133	T1	1.13 ± 0.35^a a p < 0.05 vs. t0 stage.	1.23 ± 0.35^a a p < 0.05 vs. t0 stage. ,^c c p < 0.05 vs. low map.	0.36 ± 0.11^c c p < 0.05 vs. low map.	0.39 ± 0.12
		T2	1.43 ± 0.35^a a p < 0.05 vs. t0 stage. ,^c c p < 0.05 vs. low map.	1.51±0.31^a a p < 0.05 vs. t0 stage. ,^b b p < 0.05 vs. t1 stage. ,^c c p < 0.05 vs. low map.	0.58±0.25^a a p < 0.05 vs. t0 stage. ,^c c p < 0.05 vs. low map.	0.67 ± 0.33^a a p < 0.05 vs. t0 stage. ,^b b p < 0.05 vs. t1 stage. ,^c c p < 0.05 vs. low map.
		T0	0.65 ± 0.18	0.52 ± 0.26	0.25 ± 0.13	0.33 ± 0.32
High MAP	84	T1	0.82 ± 0.34	0.88 ± 0.33^a a p < 0.05 vs. t0 stage. ,^d d p < 0.05 vs. medium map.	0.59 ± 0.32^a a p < 0.05 vs. t0 stage. ,^c c p < 0.05 vs. low map. ,^d d p < 0.05 vs. medium map.	0.69 ± 0.35^a a p < 0.05 vs. t0 stage. ,^c c p < 0.05 vs. low map. ,^d d p < 0.05 vs. medium map.
High MAP	84	T2	0.92 ± 0.19^d d p < 0.05 vs. medium map.	0.96 ± 0.42^a a p < 0.05 vs. t0 stage.	1.01 ± 0.54^a a p < 0.05 vs. t0 stage. ,^b b p < 0.05 vs. t1 stage. ,^c c p < 0.05 vs. low map. ,^d d p < 0.05 vs. medium map.	1.11 ± 0.49^a a p < 0.05 vs. t0 stage. ,^b b p < 0.05 vs. t1 stage. ,^d d p < 0.05 vs. medium map.

	Low MAP		Medium MAP		High MAP
	r	p-value	r	p-value	r	p-value
MAP and IL-4	0.11	0.00	0.33	0.00	0.16	0.00
MAP and IL-10	0.86	0.00	0.91	0.00	0.77	0.00
MAP and IL-6	0.76	0.00	0.79	0.00	0.63	0.00
MAP and TNF-α	0.70	0.00	0.65	0.00	0.66	0.00

	No	Time point	MAP	CVP	CO	CI
Low MAP	59	0 min	51.06 ± 5.35	2.34 ± 0.81	3.02 ± 0.64	2.05 ± 0.39
		10 min	56.55 ± 4.13	3.13 ± 0.65	3.71 ± 0.62	2.33 ± 0.20
		20 min	60.12 ± 3.01	3.61 ± 0.78	3.82 ± 0.51	2.55 ± 0.39
		30 min	63.54 ± 2.88	4.60 ± 1.19	4.15 ± 0.75	2.79 ± 0.38
		40 min	63.44 ± 2.83	4.56 ± 2.03	4.25 ± 1.01	2.76 ± 0.42
		50 min	65.23 ± 3.25	4.21 ± 0.82	4.44 ± 1.89	2.65 ± 0.48
		60 min	64.08 ± 4.25	4.45 ± 0.75	4.35 ± 1.25	2.66 ± 0.57
		0 min	50.21 ± 4.03	2.71 ± 0.82	3.11 ± 0.43	2.00 ± 0.27
		10 min	56.39 ± 5.11	3.75 ± 0.93	3.78 ± 0.42	2.26 ± 0.35
		20 min	62.05 ± 3.55	4.98 ± 1.74^a a p < 0.05 vs low map group.	4.13 ± 0.42^a a p < 0.05 vs low map group.	2.47 ± 0.21^a a p < 0.05 vs low map group.
Medium MAP	133	30 min	67.86 ± 3.89^a a p < 0.05 vs low map group.	5.82 ± 2.01^a a p < 0.05 vs low map group.	4.53 ± 0.45^a a p < 0.05 vs low map group.	2.71 ± 0.21^a a p < 0.05 vs low map group.
		40 min	69.55 ± 5.68^a a p < 0.05 vs low map group.	7.05 ± 1.99^a a p < 0.05 vs low map group.	4.90 ± 0.50^a a p < 0.05 vs low map group.	2.93 ± 0.27^a a p < 0.05 vs low map group.
		50 min	67.45 ± 2.64^a a p < 0.05 vs low map group.	6.95 ± 2.11^a a p < 0.05 vs low map group.	4.67 ± 0.43^a a p < 0.05 vs low map group.	2.79 ± 0.22^a a p < 0.05 vs low map group.
		60 min	68.56 ± 1.75^a a p < 0.05 vs low map group.	7.62 ± 1.25^a a p < 0.05 vs low map group.	5.19 ± 0.52^a a p < 0.05 vs low map group.	3.10 ± 0.28^a a p < 0.05 vs low map group.
		0 min	49.23 ± 4.23	2.65 ± 1.00	3.42 ± 0.33^b b p < 0.05 vs. medium map group.	2.06 ± 0.22
		10 min	57.55 ± 4.09	3.80 ± 1.24	4.10 ± 0.93^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.	2.72 ± 0.26^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.
		20 min	66.80 ± 2.45^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.	4.70 ± 1.66^a a p < 0.05 vs low map group.	4.53 ± 0.38^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.	2.96 ± 0.31^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.
High MAP	84	30 min	72.41 ± 2.41^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.	6.25 ± 1.59^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.	4.87 ± 0.41^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.	3.06 ± 0.32^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.
		40 min	74.06 ± 2.83^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.	7.35 ± 1.42^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.	4.96 ± 0.37^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.	3.13 ± 0.32^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.
		50 min	73.28 ± 2.69^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.	7.81 ± 2.28^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.	5.06 ± 0.38^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.	3.09 ± 0.32^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.
		60 min	73.76 ± 2.62^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.	8.05 ± 2.61^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.	5.18 ± 0.34^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.	3.15 ± 0.31^a a p < 0.05 vs low map group. ,^b b p < 0.05 vs. medium map group.

Faculdade de Medicina / USP Rua Dr Ovídio Pires de Campos, 225 - 6 and., 05403-010 São Paulo SP - Brazil, Tel.: (55 11) 2661-6235 - São Paulo - SP - Brazil
E-mail: clinics@hc.fm.usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] ⁎ Corresponding author. E-mail address: zzzlhong_wl1214@hotmail.com (L. Zhang).