Esophageal Doppler-guided fluid management decreases blood lactate levels in multiple-trauma patients:: a randomized controlled trial
Esophageal Doppler-guided fluid management decreases blood lactate levels in multiple-trauma patients:: a randomized controlled trial
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DOI：
10.1186/cc5703
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发表时间：
2007-01-01
期刊：
影响因子：
15.1
通讯作者：
Zidkova, Alexandra
中科院分区：
文献类型：
--
作者：
Chytra, Ivan;Pradl, Richard;Zidkova, Alexandra
食管多普勒是一种有用的无创工具，可用于择期手术补液。本研究的目的是评估早期食管多普勒优化血管内容量对多创伤患者血乳酸水平和器官功能障碍发展的影响，并与标准血流动力学管理进行比较。方法采用随机对照试验。重症监护病房（ICU）入院的失血超过2000 ml的多发创伤患者随机分为方案组和对照组，并进行食管多普勒监测。多普勒组在ICU前12小时根据食管多普勒数据指导液体复苏，而对照组则按常规处理。观察ICU住院期间血乳酸水平及脏器功能障碍。结果随机分为多普勒治疗组80例，对照组82例。多普勒组在ICU住院前12小时静脉注射胶体较多（1667 +/- 426 ml比682 +/- 322 ml， p < 0.0001），多普勒组在治疗后12、24小时血乳酸水平均低于对照组（2.92 +/- 0.54 mmol/l比3.23 +/- 0.54 mmol/l [p = 0.0003]和1.99 +/- 0.44 mmol/l比2.37 +/- 0.58 mmol/l [p < 0.0001]）。两组间器官功能障碍无差异。多普勒组出现感染并发症的患者较少（15例[18.8%]vs 28例[34.1%]；相对危险度= 0.5491；95%可信区间= 0.3180 ~ 0.9482;p = 0.032）。多普勒组患者ICU住院时间中位数由8.5天（四分位间距[IQR] 6 ~ 16）降至7天（IQR 6 ~ 11） （p = 0.031），住院时间中位数由17.5天（IQR 11 ~ 29）降至14天（IQR 8.25 ~ 21） （p = 0.045）。两组间ICU和医院死亡率无显著差异。结论应用食管多普勒优化血管内容积与降低血乳酸水平、降低感染并发症发生率、缩短ICU和住院时间有关。
Introduction Esophageal Doppler was confirmed as a useful non-invasive tool for management of fluid replacement in elective surgery. The aim of this study was to assess the effect of early optimization of intravascular volume using esophageal Doppler on blood lactate levels and organ dysfunction development in comparison with standard hemodynamic management in multiple-trauma patients.Methods This was a randomized controlled trial. Multiple-trauma patients with blood loss of more than 2,000 ml admitted to the intensive care unit ( ICU) were randomly assigned to the protocol group with esophageal Doppler monitoring and to the control group. Fluid resuscitation in the Doppler group was guided for the first 12 hours of ICU stay according to the protocol based on data obtained by esophageal Doppler, whereas control patients were managed conventionally. Blood lactate levels and organ dysfunction during ICU stay were evaluated.Results Eighty patients were randomly assigned to Doppler and 82 patients to control treatment. The Doppler group received more intravenous colloid during the first 12 hours of ICU stay ( 1,667 +/- 426 ml versus 682 +/- 322 ml; p < 0.0001), and blood lactate levels in the Doppler group were lower after 12 and 24 hours of treatment than in the control group ( 2.92 +/- 0.54 mmol/l versus 3.23 +/- 0.54 mmol/l [ p = 0.0003] and 1.99 +/- 0.44 mmol/l versus 2.37 +/- 0.58 mmol/l [ p < 0.0001], respectively). No difference in organ dysfunction between the groups was found. Fewer patients in the Doppler group developed infectious complications ( 15 [ 18.8%] versus 28 [ 34.1%]; relative risk = 0.5491; 95% confidence interval = 0.3180 to 0.9482; p = 0.032). ICU stay in the Doppler group was reduced from a median of 8.5 days ( interquartile range [ IQR] 6 to 16) to 7 days ( IQR 6 to 11) ( p = 0.031), and hospital stay was decreased from a median of 17.5 days ( IQR 11 to 29) to 14 days ( IQR 8.25 to 21) ( p = 0.045). No significant difference in ICU and hospital mortalities between the groups was found.Conclusion Optimization of intravascular volume using esophageal Doppler in multiple-trauma patients is associated with a decrease of blood lactate levels, a lower incidence of infectious complications, and a reduced duration of ICU and hospital stays.