Non-invasive hemodynamic monitoring in the acute period of polytrauma as a method to control and correction respiratory and circulatory disorders
Objective – to establish the value of non-invasive monitoring of central hemodynamics during the acute period of polytrauma and its impact on systemic respiratory and circulatory parameters and intensive care treatment using the estimated Continuous Cardiac Output (esCCO), a non-invasive continuous measurement technique of central hemodynamics, which was integrated into the Life Scope monitor (Nihon Kohden, Japan). module.
Materials and methods. The study included 170 patients with polytrauma who were treated in our intensive care unit. Patients with severe polytrauma (ISS 20–30 points) were included in the group 1 (n = 70), with an average age of (41.9 ± 2.4) years. The group 2 (n = 100) consisted of patients with moderate polytrauma (ISS 10–19 points), the average age of the patients in this group was (38.7 ± 2.5) years. In sub-groups 1А and 2А adequate circulating blood volume measurement and subsequent support was performed using the esCCO. In subgroups 1B and 2B, the analysis of systemic hemodynamics such as ECG and blood saturation was performed using standard multifunction monitors.
Results. Hemodynamic disorders in the form of arterial hypotension < 70 mm Hg on admission occurred in 14.3 % of patients in group 1, and was not observed in patients within the group 2. The normalization of systemic hemodynamics was observed after 24 hours of intensive care therapy, in particular in subgroup 1А a marked increase in the systemic blood pressure and subsequent termination of tachycardia was observed. Normalization of cardiac output and cardiac index in subgroup 1А was observed after 3–6 h of infusion therapy (IT), in the subgroup 2А – after 12 h IT. In the subgroup 1А the infusion volume during the first day differed significantly, 8.9 % less if compared to the infusion volume used in subgroup 1B. In moderate-severity polytrauma, the infusion volume was significantly smaller than in severe polytrauma, and in the subgroup 2А it was significantly lower by 8.6 %, compared to the infusion volume used in the subgroup 2B. The confirmation of the effectiveness of the balanced IT was the normalization of the urine output. Namely: on day 2 in the subgroup 1А the diuresis increased significantly compared to day 1, and in the subgroup 1B it did not change significantly. Intergroup differences in mean daily diuresis in the group 2 were significant after 12 h of IT.
Conclusions. Carrying out monitor-controlled infusion and respiratory therapy with the usage of the esCCO monitoring technique allowed to achieve an early normalization of central and systemic hemodynamics during the intensive care of polytrauma patients with a significantly smaller volume of infusion, contributed to the elimination of hypoxia, and was accompanied by a significant reduction, namely by 21.1 %, in the duration of mechanical ventilation in severe polytrauma.
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