Hemodynamic Patterns of Blunt and Penetrating Injuries》.pdfVIP

Hemodynamic Patterns of Blunt and Penetrating Injuries Kevin Jun-Qiang Lu, MD, Li-Chien Chien, MD, Charles CJ Wo, BS, Demetrios Demetriades, MD, PhD, FACS, William C Shoemaker, MD BACKGROUND: The aims of this prospective observational study were to describe early hemodynamic patterns of blunt and penetrating truncal injury and to evaluate outcomes prediction using noninvasive hemo- dynamic monitoring with a mathematical model tested against actual in-hospital outcomes. The hypothesis was that traumatic shock is a circulatory disorder that can be monitored by noninvasive hemodynamic parameters that reflect cardiac, pulmonary, and tissue perfusion functions. STUDY DESIGN: The cardiac index (CI), heart rate (HR), mean arterial pressure (MAP), pulse oximetry (SapO ), 2 transcutaneous oxygen tension indexed to FiO (PtcO /FiO ), and carbon dioxide (PtcCO ) 2 2 2 2 tensions were monitored beginning shortly after emergency department admission in 657 emergency patients with severe blunt and penetrating chest, abdominal, and extremity trauma. Of these, 113 patients had associated head injury, and these patients also were analyzed sepa- rately. A search and display mathematical model, with a decision support program, was based on continuous online, real-time, noninvasive hemodynamic monitoring. RESULTS: There were similar patterns in the blu