Strategy of infusion therapy in the acute period of polytrauma based on noninvasive continuous hemodynamic monitoring
DOI:
https://doi.org/10.11603/2414-4533.2019.2.10333Keywords:
polytrauma, infusion therapy, noninvasive hemodynamic monitoringAbstract
The aim of the work: to establish the effectiveness of non-invasive monitoring of cardiac output as guidance for infusion therapy in the treatment of acute polytrauma.
Materials and Methods. We examined 50 patients with polytrauma who were delivered to the Department of Anesthesiology and Intensive Care (ICU) of the Lviv City Emergency Hospital. The average age of the patients was (48.4±5.2) years. The main group consisted of 25 patients, in which the monitoring of central hemodynamics was performed with usage of the esCCO module, integrated into Nihon Kohden’s Life Scope patient monitor (Japan). In patients, who were considered susceptible to infusion therapy to replenish the circulating blood volume, infusion boluses of a volume of 500–1000 ml balanced crystalloid solutions caused a significant increase in cardiac output and stroke volume. In the control group (n = 25) we performed a comparative analysis using only traditional indicators such as arterial blood pressure (BP), ECG and blood oxygen saturation (SpO2), which were recorded with Philips IntelliVue (MP20) multifunction monitors.
Results and Discussion. In the main group, the daily volume of infusion was lower and amounted to (4666.7±120.3) ml, differing significantly from the volume of infusion (p<0.05) in the control group. In the main group, the mean cardiac output (CO) at the time of hospitalization was (4.06±0.10) l/min, which was significantly lower in comparison to the control group (p<0.05); after 12 hours of treatment, the CO continued to increase notably and compared with the term of 6 hours, it increased up to (5.30±0.06) l/min (p <0.01). After 24 hours of intensive care therapy, as opposed to the control group, significant dynamics of the CO growth of the patients in the main group were noted up to (5.63±0.08) l/min, being close to normal ranges. The diuresis during the first 12 hours in the control group was (887.5±95.3) ml and increased up to (1987.5±257.3) ml during first 24 hours (the increase in diuresis during the first 24 hours was 91.7 ml/h). In the main group the initial diuresis was (942.9±75.1) ml (p>0.5) and (2585.7±101.0) ml (p<0.05) after 24 hours (the increase in diuresis during the first 24 hours was 136.9 ml/h).
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