Department of Critical Care, King's College Hospital NHS Foundation Trust, London, United Kingdom.
Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, United Kingdom.
Crit Care Med. 2018 Sep;46(9):e889-e896. doi: 10.1097/CCM.0000000000003275.
To assess the relationship between microcirculatory perfusion and multiple organ dysfunction syndrome in patients following traumatic hemorrhagic shock.
Multicenter prospective longitudinal observational study.
Three U.K. major trauma centers.
Fifty-eight intubated and ventilated patients with traumatic hemorrhagic shock.
Sublingual incident dark field microscopy was performed within 12 hours of ICU admission (D0) and repeated 24 and 48 hours later. Cardiac output was assessed using oesophageal Doppler. Multiple organ dysfunction syndrome was defined as Serial Organ Failure Assessment score greater than or equal to 6 at day 7 post injury.
Data from 58 patients were analyzed. Patients had a mean age of 43 ± 19 years, Injury Severity Score of 29 ± 14, and initial lactate of 7.3 ± 6.1 mmol/L and received 6 U (interquartile range, 4-11 U) of packed RBCs during initial resuscitation. Compared with patients without multiple organ dysfunction syndrome at day 7, patients with multiple organ dysfunction syndrome had lower D0 perfused vessel density (11.2 ± 1.8 and 8.6 ± 1.8 mm/mm; p < 0.01) and microcirculatory flow index (2.8 [2.6-2.9] and 2.6 [2.2-2.8]; p < 0.01) but similar cardiac index (2.5 [± 0.6] and 2.1 [± 0.7] L/min//m; p = 0.11). Perfused vessel density demonstrated the best discrimination for predicting subsequent multiple organ dysfunction syndrome (area under curve 0.87 [0.76-0.99]) compared with highest recorded lactate (area under curve 0.69 [0.53-0.84]), cardiac index (area under curve 0.66 [0.49-0.83]) and lowest recorded systolic blood pressure (area under curve 0.54 [0.39-0.70]).
Microcirculatory hypoperfusion immediately following traumatic hemorrhagic shock and resuscitation is associated with increased multiple organ dysfunction syndrome. Microcirculatory variables are better prognostic indicators for the development of multiple organ dysfunction syndrome than more traditional indices. Microcirculatory perfusion is a potential endpoint of resuscitation following traumatic hemorrhagic shock.
评估创伤性失血性休克患者微循环灌注与多器官功能障碍综合征之间的关系。
多中心前瞻性纵向观察性研究。
英国 3 家主要创伤中心。
58 例气管插管和机械通气的创伤性失血性休克患者。
在入住 ICU 后 12 小时内（D0）进行舌下微暗视野显微镜检查，并在 24 小时和 48 小时后重复检查。使用食道多普勒评估心输出量。多器官功能障碍综合征定义为损伤后第 7 天序贯器官衰竭评估评分大于或等于 6。
分析了 58 例患者的数据。患者的平均年龄为 43 ± 19 岁，损伤严重程度评分 29 ± 14，初始乳酸值为 7.3 ± 6.1 mmol/L，并在初始复苏期间接受了 6 U（四分位距，4-11 U）的浓缩红细胞。与第 7 天无多器官功能障碍综合征的患者相比，有多器官功能障碍综合征的患者在 D0 时灌注血管密度较低（11.2 ± 1.8 和 8.6 ± 1.8 mm/mm；p < 0.01）和微循环血流指数较低（2.8 [2.6-2.9] 和 2.6 [2.2-2.8]；p < 0.01），但心指数相似（2.5 [± 0.6] 和 2.1 [± 0.7] L/min/m；p = 0.11）。与最高记录的乳酸（曲线下面积 0.69 [0.53-0.84]）、心指数（曲线下面积 0.66 [0.49-0.83]）和最低记录的收缩压（曲线下面积 0.54 [0.39-0.70]）相比，灌注血管密度对预测随后发生的多器官功能障碍综合征具有最佳的区分能力（曲线下面积 0.87 [0.76-0.99]）。
创伤性失血性休克复苏后即刻的微循环灌注不足与多器官功能障碍综合征的发生有关。与传统指标相比，微循环变量是多器官功能障碍综合征发生的更好预后指标。微循环灌注是创伤性失血性休克复苏的潜在终点。
