The dynamics of markers of a shock state in traumatic blood loss depending on fluid resuscitation type.

D. A. Krishtafor; O. M. Klygunenko

doi:10.26641/2307-0404.2017.4.117672

Автор(и)

D. A. Krishtafor
O. M. Klygunenko

DOI:

https://doi.org/10.26641/2307-0404.2017.4.117672

Ключові слова:

multiple trauma, bleeding, bleeding management, multiple organ failure, liberal fluid resuscitation, restrictive fluid resuscitation

Анотація

The aim of the study was to determine the effect of quantitative and qualitative changes in fluid resuscitation on the dynamics of markers of the shock state in patients with multiple trauma. 73 patients with multiple trauma were divided into two groups, depending on the fluid resuscitation type (liberal or restrictive). The parameters of hemodynamics, hourly diuresis, general blood test, coagulogram, acid-base and gas composition of blood were studied. A decrease in the infusion volume in traumatic blood loss due to the restriction of the crystalloids and colloids volume allowed to effectively reduce such manifestations of shock as hypotension, tachycardia and acidosis, to provide an adequate rate of diuresis. In restrictive infusion group the duration of vasopressor support was shorter, the fluctuations in peripheral blood parameters were less pronounced, coagulation normalized earlier, positive water balance was significantly lower, mortality and the number of complications were reduced. Restriction of fluid resuscitation volume allows to successfully treat shock and decrease multiple organ dysfunction, number of complications and mortality.

Біографії авторів

D. A. Krishtafor

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
Department of Anesthesiology, Intensive Therapy and Medicine of emergency conditions
of Postgraduate Education Faculty
V. Vernadsky str., 9, Dnipro, 49044, Ukraine

O. M. Klygunenko

SE «Dnipropetrovsk medical academy of Health Ministry of Ukraine»
Department of Anesthesiology, Intensive Therapy and Medicine of emergency conditions
of Postgraduate Education Faculty
V. Vernadsky str., 9, Dnipro, 49044, Ukraine

Посилання

Kobelyatskiy YuYu,YovenkoIA, Tsarev AV, et al. [Intensive care of multiple trauma from modern international guidelines positions]. Medycyna nevidkladnyh staniv. 2013;7(54):9-14. Russian.

Kligunenko EN, Sedinkin VA. [The effectiveness of restrictive type of replenishment of acute obstetric blood loss]. Zbіrnik naukovikh prats' spіvrobіtnikіv NMAPO іm. P.L. Shupika. Kyiv, 2015;26:132-6. Russian.

Roshchіn GG, Guriev SO,BaramіyaNM, Krilyuk VO. [Unresolved issues of emergency medical care in victims of severe combined injuries: Problems of military healthcare]. Kyiv; 2012. Russian.

Timerbulatov ShV, Fayazov RR, Smyr RA, et al. [Determination of the volume and severity of acute blood loss]. Meditsinskiy vestnik Bashkortostana. 2012;2:69-72. Russian.

YovenkoIA, Kobelyatskiy YuYu, Tsarev AV, et al. [The practice of fluid therapy of bleeding in severe gunshot trauma: the choice of drugs and target endpoints]. Medycyna nevidkladnyh staniv. 2015;2(65):164-70. Russian.

[Ministry of Health ofUkraine(2002). About approving methods of measuring the medical and biological indicators (Order N 417 from 15.11.2002)]. Available from: http://mozdocs.kiev.ua/view.php?id=1960. Ukrainian.

Usenko LV, Tsarev AV, Petrov VV, Kobelyatskiy YuYu. [Modern principles of fluid management of bleeding in multiple trauma and massive transfusion protocol]. Gematologiya. Transfuziologiya. Vostochnaya Evropa. 2016;1(2):64-75. Russian.

SokolovVA.[Multiple and combined injuries]. Moskva: GEOTAR-media; 2006. Russian.

Usenko LV, Tsarev AV. [Cardiopulmonary and cerebral resuscitation: Guidelines]. Dnipropetrovsk. 2007;47. Russian.

Chappell D, Jacob M, Hofmann-Kiefer K, et al. A rational approach to perioperative fluid management. Anesthesiology. 2008;109(4):723-740. doi: 10.1097/ALN.0b013e3181863117.

Frith D, Goslings JC, Gaarder C, et al. Definition and drivers of acute traumatic coagulopathy: clinical and experimental investigations. Journal of Thrombosis & Haemostasis. 2010;8:1919-25. doi: 10.1111/j.1538-7836.2010.03945.x.

Cothren CC, Moore EE, Hedegaard HB, Meng K. Epidemiology of urban trauma deaths: a comprehensive reassessment 10 years later. World J Surg. 2007;31(7):1507-11.

Duke MD, Guidry C, Guice J, et al. Restrictive fluid resuscitation in combination with damage control resuscitation: time for adaptation. J Trauma Acute Care Surg. 2012;73(3):674-8. doi: 10.1097/TA.0b013e318265ce1f.

Zander R, Engelhard K, Werner C. Volume causes pressure. Cranial, thoracic, vascular and abdominal. Anaesthesist. 2009;58(4):341-2. doi: 10.1007/s00101-009-1520-5.