Are we meeting current recommendations for the initial management of penetrating trauma? A preliminary analysis from a Colombian institutional registry

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• 作者：Fredy Ariza^a ; ^{fredyariza@hotmail.com} ; Beatriz Elena Sá ; nchez^a ; Alberto Federico Garc&iacute ; a^b ; Fernando Raffá ; n-Sanabria^c ; Manuel Quintana-D&iacute ; az^d ; Jorge Humberto Mej&iacute ; a-Mantilla^a
• 关键词：Mortality ; Tranexamic acid ; Blood coagulation disorders ; Multiple trauma ; Abdomen
• 刊名：Colombian Journal of Anesthesiology
• 出版年：2017
• 出版时间：January-March 2017
• 年：2017
• 卷：45
• 期：1
• 页码：39-45
• 全文大小：739 K
• 卷排序：45

文摘

To achieve minimal physiological goals in patients with penetrating thoraco-abdominal trauma (TAPT) is essential to ensure adequate outcomes.ObjectivesTo determine the success in meting basic standards at the end of damage control surgery in subjects with TAPT: (1) Monitoring and prevention of hyperfibrinolysis; (2) central temperature >35 &deg;C; (3) platelet count >50,000/mm3 and serum fibrinogen >150 mg/dl; (4) hemoglobin levels >7.5 mg/dl and base deficit <6.MethodsSubjects >18 years old undergoing damage control surgery as a result of TAPT were prospectively collected at a referral center between October Oct-2012 and Dec-2014. Comparisons were done according to the Injury Severity Score (ISS) with a severity value indicator of >25. A p < 0.05 value was considered significant.Results106 subjects with TAPT were enrolled. Administration of tranexamic acid was only reported in 52.7% of the patients, particularly in the group with low severity scores [Group ISS ≤ 25 36.3% vs. group ISS > 25 65.8%. OR 3.37 (95% CI 1.2&ndash;9.85); p = 0.01]. Although the temperature was reported in 91% of the cases, only 66.2&ndash;71.4% reached the recommended goal. Serum fibrinogen was measured in 59.5% of the cases and only 52% met the recommended level. The base deficit values of <6 at the end of surgery were only accomplished in 40&ndash;43.8% of the subjects, with a significantly lower probability in the more severe patients [53% vs. 35.9%. OR 2.04 (95% CI 1.2&ndash;6.02); p = 0.042].ConclusionsA considerable proportion of patients with TAPT does not meet the current recommendations at the end of damage control surgery.