Application of ultrasound-guided volume resuscitation in severe trauma patients

Abstract

Objective To investigate the role of ultrasound-guided volume resuscitation in the treatment of severe trauma. Methods Sixty patients with severe trauma requiring surgical intervention were included and randomly assigned into the ultrasound-guided volume resuscitation group （group U， n = 30） and the empirical treatment group （group C， n = 30） using the random number table method. All patients underwent general anesthesia induction， central venous catheterization and subsequent surgery. In group U， ultrasound examination was conducted for assessing the inferior vena cava （IVC）， aortic root peak velocity variation （ΔVpeak） and time integral variation of aortic root velocity （ΔVTI） upon arrival at the operating room， after general anesthesia induction， at the end of operation and upon resuscitation， respectively. Fluid resuscitation therapy in group U was guided based on these results. In group C， patients were subjected to fluid resuscitation based on heart rate （HR）， mean arterial pressure （MAP）， central venous pressure （CVP）， fluid load test and blood gas analysis results， etc. Radial artery blood samples were collected from all patients immediately upon arrival at the OR （T0）， at 1 h （T1）， 2 h （T2）， 4 h （T3）， 6 h （T4）， and 24 h （T5） post-arrival， and lactate levels along with other blood gas analysis results were recorded accordingly. Additionally， the total amount of crystalloids and colloids administered from 0-<1 h，1-<2 h， 2-<4 h， 4-6 h， and 0-6 h since arrival were documented. The operation time， anesthesia duration， postoperative recovery time， extubation time， blood loss volume， urine output， duration of hypotension， duration of elevated lactate levels， length of hospital stay， ICU transfer rate， 28-d mortality rate， and the total amount of norepinephrine use were recorded. Results Compared with T0， lactate levels in group U exhibited an increase at T1 and T2， and followed by a return to normal levels at T4. In group C， an elevation in lactate levels was demonstrated at T1~T3， which subsequently decreased to normal levels at T5. Patients in group U displayed lower lactate levels at both T2 and T3 than those in group C. Additionally， patients in group U exhibited reduced overall usage of norepinephrine and a shorter duration of elevated lactate levels. Moreover， patients in group U received a higher volume of crystalloid fluids during the initial hour （0-<1 h）， and lesser amounts during 2-<4 h and 4-6 h as well as overall within 0-6 h， respectively. Furthermore， compared to the group C， there was less administration of colloid fluids during 2-<4 h and overall within 0-6 h in group U （all P < 0.05）. However， no statistically significant differences were observed in the operation time， anesthesia duration， postoperative recovery time， extubation time， length of hospital stay， intraoperative blood loss， transfusion volume， oxygenation index， urine output or duration of hypotension between two groups （all P > 0.05）. Conclusion Ultrasound-guided volume resuscitation can be safely employed in severe trauma patients， which can reduce the total amount of transfusion， decrease the total dosage of vasoactive medications， and shorten the duration of elevated lactate levels.

Keywords

• ultrasound|volume resuscitation|severe trauma|inferior vena cava|lactic acid