Hemodynamic reactions in patients with hemorrhagic shock from blunt trauma after initial fluid therapy

Akiyoshi Hagiwara, Akio Kimura, Hiroshi Kato, Yasuaki Mizushima, Tetsuya Matsuoka, Munekazu Takeda, Toshifumi Uejima, Yusuke Hagiwara, Yuichiro Sakamoto, Daisuke Kudo, Junichi Sasaki

研究成果: Article

12 引用 (Scopus)

抄録

Object: This study sought to define hemorrhagic shock from blood pressure and heart rate and then to provide a treatment policy based on response to initial fluid therapy. Materials: This was a prospective clinical observational study conducted in eight hospitals. Subjects were consecutive patients with trauma who met any of the field triage conditions proposed by the Committee on Trauma of the American College of Surgeons. Initial fluid therapy was performed in patients with suspected hemorrhagic shock. Patients who required blood transfusion ≥4 U within 24 hours or interventions for active bleeding within 24 hours were classified into a "bleeding group" (B). A "nonbleeding group" (non-B) comprised patients who did not require blood transfusion ≥4 U or other interventions within 24 hours. Our committee maintained the database of survey items. Four of the hospitals were selected at random to provide training data and that was used in a recursive partitioning analysis to predict the B group. Data on patients in the other four facilities were used for validation. Results: There were a total of 400 patients studied. The training set consisted of 261 patients, 50 of whom were classified into the B group. A total of 94% patients with hemorrhagic shock suspected clinically, shock index at admission (first SI) ≥0.8, and SI at 1 L of fluid resuscitation (second SI) ≥1.0 were assigned to the B group. The non-B group (92%) were patients those whose first SI was <0.8 and base deficits at admission ≥-1.0. Validation data consisted of 139 patients. The sensitivity, specificity, and accuracy of these data to predict the B group were 71%, 93%, and 89%, respectively. Conclusions: Patients whose first SI was ≥0.8 and second SI ≥1.0 would be diagnosed as "nonresponders" by American College of Surgeons. Patients with first SI <0.8 and base deficits ≥-1.0 will not be candidates for the B group.

元の言語English
ページ(範囲)1161-1168
ページ数8
ジャーナルJournal of Trauma - Injury, Infection and Critical Care
69
発行部数5
DOI
出版物ステータスPublished - 2010 11
外部発表Yes

Fingerprint

Hemorrhagic Shock
Fluid Therapy
Hemodynamics
Wounds and Injuries
Blood Transfusion
Hemorrhage
Triage
Resuscitation
Observational Studies
Shock
Heart Rate
Databases

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

これを引用

Hemodynamic reactions in patients with hemorrhagic shock from blunt trauma after initial fluid therapy. / Hagiwara, Akiyoshi; Kimura, Akio; Kato, Hiroshi; Mizushima, Yasuaki; Matsuoka, Tetsuya; Takeda, Munekazu; Uejima, Toshifumi; Hagiwara, Yusuke; Sakamoto, Yuichiro; Kudo, Daisuke; Sasaki, Junichi.

:: Journal of Trauma - Injury, Infection and Critical Care, 巻 69, 番号 5, 11.2010, p. 1161-1168.

研究成果: Article

Hagiwara, A, Kimura, A, Kato, H, Mizushima, Y, Matsuoka, T, Takeda, M, Uejima, T, Hagiwara, Y, Sakamoto, Y, Kudo, D & Sasaki, J 2010, 'Hemodynamic reactions in patients with hemorrhagic shock from blunt trauma after initial fluid therapy', Journal of Trauma - Injury, Infection and Critical Care, 巻. 69, 番号 5, pp. 1161-1168. https://doi.org/10.1097/TA.0b013e3181d27c94
Hagiwara, Akiyoshi ; Kimura, Akio ; Kato, Hiroshi ; Mizushima, Yasuaki ; Matsuoka, Tetsuya ; Takeda, Munekazu ; Uejima, Toshifumi ; Hagiwara, Yusuke ; Sakamoto, Yuichiro ; Kudo, Daisuke ; Sasaki, Junichi. / Hemodynamic reactions in patients with hemorrhagic shock from blunt trauma after initial fluid therapy. :: Journal of Trauma - Injury, Infection and Critical Care. 2010 ; 巻 69, 番号 5. pp. 1161-1168.
@article{007399b4761949d3819ee389c4b5ec0c,
title = "Hemodynamic reactions in patients with hemorrhagic shock from blunt trauma after initial fluid therapy",
abstract = "Object: This study sought to define hemorrhagic shock from blood pressure and heart rate and then to provide a treatment policy based on response to initial fluid therapy. Materials: This was a prospective clinical observational study conducted in eight hospitals. Subjects were consecutive patients with trauma who met any of the field triage conditions proposed by the Committee on Trauma of the American College of Surgeons. Initial fluid therapy was performed in patients with suspected hemorrhagic shock. Patients who required blood transfusion ≥4 U within 24 hours or interventions for active bleeding within 24 hours were classified into a {"}bleeding group{"} (B). A {"}nonbleeding group{"} (non-B) comprised patients who did not require blood transfusion ≥4 U or other interventions within 24 hours. Our committee maintained the database of survey items. Four of the hospitals were selected at random to provide training data and that was used in a recursive partitioning analysis to predict the B group. Data on patients in the other four facilities were used for validation. Results: There were a total of 400 patients studied. The training set consisted of 261 patients, 50 of whom were classified into the B group. A total of 94{\%} patients with hemorrhagic shock suspected clinically, shock index at admission (first SI) ≥0.8, and SI at 1 L of fluid resuscitation (second SI) ≥1.0 were assigned to the B group. The non-B group (92{\%}) were patients those whose first SI was <0.8 and base deficits at admission ≥-1.0. Validation data consisted of 139 patients. The sensitivity, specificity, and accuracy of these data to predict the B group were 71{\%}, 93{\%}, and 89{\%}, respectively. Conclusions: Patients whose first SI was ≥0.8 and second SI ≥1.0 would be diagnosed as {"}nonresponders{"} by American College of Surgeons. Patients with first SI <0.8 and base deficits ≥-1.0 will not be candidates for the B group.",
keywords = "Base deficits, Blunt trauma, Hemorrhagic shock, Initial fluid resuscitation, Shock index",
author = "Akiyoshi Hagiwara and Akio Kimura and Hiroshi Kato and Yasuaki Mizushima and Tetsuya Matsuoka and Munekazu Takeda and Toshifumi Uejima and Yusuke Hagiwara and Yuichiro Sakamoto and Daisuke Kudo and Junichi Sasaki",
year = "2010",
month = "11",
doi = "10.1097/TA.0b013e3181d27c94",
language = "English",
volume = "69",
pages = "1161--1168",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Hemodynamic reactions in patients with hemorrhagic shock from blunt trauma after initial fluid therapy

AU - Hagiwara, Akiyoshi

AU - Kimura, Akio

AU - Kato, Hiroshi

AU - Mizushima, Yasuaki

AU - Matsuoka, Tetsuya

AU - Takeda, Munekazu

AU - Uejima, Toshifumi

AU - Hagiwara, Yusuke

AU - Sakamoto, Yuichiro

AU - Kudo, Daisuke

AU - Sasaki, Junichi

PY - 2010/11

Y1 - 2010/11

N2 - Object: This study sought to define hemorrhagic shock from blood pressure and heart rate and then to provide a treatment policy based on response to initial fluid therapy. Materials: This was a prospective clinical observational study conducted in eight hospitals. Subjects were consecutive patients with trauma who met any of the field triage conditions proposed by the Committee on Trauma of the American College of Surgeons. Initial fluid therapy was performed in patients with suspected hemorrhagic shock. Patients who required blood transfusion ≥4 U within 24 hours or interventions for active bleeding within 24 hours were classified into a "bleeding group" (B). A "nonbleeding group" (non-B) comprised patients who did not require blood transfusion ≥4 U or other interventions within 24 hours. Our committee maintained the database of survey items. Four of the hospitals were selected at random to provide training data and that was used in a recursive partitioning analysis to predict the B group. Data on patients in the other four facilities were used for validation. Results: There were a total of 400 patients studied. The training set consisted of 261 patients, 50 of whom were classified into the B group. A total of 94% patients with hemorrhagic shock suspected clinically, shock index at admission (first SI) ≥0.8, and SI at 1 L of fluid resuscitation (second SI) ≥1.0 were assigned to the B group. The non-B group (92%) were patients those whose first SI was <0.8 and base deficits at admission ≥-1.0. Validation data consisted of 139 patients. The sensitivity, specificity, and accuracy of these data to predict the B group were 71%, 93%, and 89%, respectively. Conclusions: Patients whose first SI was ≥0.8 and second SI ≥1.0 would be diagnosed as "nonresponders" by American College of Surgeons. Patients with first SI <0.8 and base deficits ≥-1.0 will not be candidates for the B group.

AB - Object: This study sought to define hemorrhagic shock from blood pressure and heart rate and then to provide a treatment policy based on response to initial fluid therapy. Materials: This was a prospective clinical observational study conducted in eight hospitals. Subjects were consecutive patients with trauma who met any of the field triage conditions proposed by the Committee on Trauma of the American College of Surgeons. Initial fluid therapy was performed in patients with suspected hemorrhagic shock. Patients who required blood transfusion ≥4 U within 24 hours or interventions for active bleeding within 24 hours were classified into a "bleeding group" (B). A "nonbleeding group" (non-B) comprised patients who did not require blood transfusion ≥4 U or other interventions within 24 hours. Our committee maintained the database of survey items. Four of the hospitals were selected at random to provide training data and that was used in a recursive partitioning analysis to predict the B group. Data on patients in the other four facilities were used for validation. Results: There were a total of 400 patients studied. The training set consisted of 261 patients, 50 of whom were classified into the B group. A total of 94% patients with hemorrhagic shock suspected clinically, shock index at admission (first SI) ≥0.8, and SI at 1 L of fluid resuscitation (second SI) ≥1.0 were assigned to the B group. The non-B group (92%) were patients those whose first SI was <0.8 and base deficits at admission ≥-1.0. Validation data consisted of 139 patients. The sensitivity, specificity, and accuracy of these data to predict the B group were 71%, 93%, and 89%, respectively. Conclusions: Patients whose first SI was ≥0.8 and second SI ≥1.0 would be diagnosed as "nonresponders" by American College of Surgeons. Patients with first SI <0.8 and base deficits ≥-1.0 will not be candidates for the B group.

KW - Base deficits

KW - Blunt trauma

KW - Hemorrhagic shock

KW - Initial fluid resuscitation

KW - Shock index

UR - http://www.scopus.com/inward/record.url?scp=78549251034&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78549251034&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e3181d27c94

DO - 10.1097/TA.0b013e3181d27c94

M3 - Article

C2 - 20489665

AN - SCOPUS:78549251034

VL - 69

SP - 1161

EP - 1168

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 5

ER -