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首页> 外文期刊>Critical care : >Esophageal Doppler-guided fluid management decreases blood lactate levels in multiple-trauma patients: a randomized controlled trial
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Esophageal Doppler-guided fluid management decreases blood lactate levels in multiple-trauma patients: a randomized controlled trial

机译：食管多普勒引导的液体管理可降低多发性创伤患者的血液乳酸水平：一项随机对照试验

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IntroductionEsophageal 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.MethodsThis 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.ResultsEighty 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 to16) 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.ConclusionOptimization 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.
机译：引言食道多普勒被确认为选择性手术中补液管理的有用的非侵入性工具。这项研究的目的是评估与多发性创伤患者的标准血液动力学管理相比，食管多普勒早期优化血管内容积对血液乳酸水平和器官功能障碍发展的影响。方法这是一项随机对照试验。重症监护病房（ICU）失血多于2,000 ml的多发伤患者被随机分配到有食管多普勒监测的治疗方案组和对照组。根据协议，基于食管多普勒获得的数据，指导多普勒组在ICU停留的前12小时进行液体复苏，而对照组则按常规进行。对ICU住院期间的血乳酸水平和器官功能障碍进行了评估。结果80例患者被随机分配到多普勒治疗，而82例患者被控制治疗。多普勒组在ICU住院的最初12小时内接受的静脉胶体更多（1,667±426 ml vs 682±322 ml; p <0.0001），在治疗12和24小时后，多普勒组的血乳酸水平低于对照组。对照组（分别为2.92±0.54 mmol / l与3.23±0.54 mmol / l [p = 0.0003]和1.99±0.44 mmol / l与2.37±0.58 mmol / l [p <0.0001]）。两组之间的器官功能障碍无差异。多普勒组中发生感染并发症的患者较少（15 [18.8％]比28 [34.1％];相对风险= 0.5491; 95％置信区间= 0.3180至0.9482; p = 0.032）。多普勒组的ICU停留时间从中位数8.5天（四分位间距[IQR] 6至16）减少到7天（IQR 6至11）（p = 0.031），住院时间从中位数17.5天减少（ IQR 11至29）至14天（IQR 8.25至21）（p = 0.045）。在各组之间，ICU和医院死亡率均无显着差异。结论多发性创伤患者使用食道多普勒优化血管内容积与血乳酸水平降低，传染性并发​​症发生率降低，ICU持续时间缩短有关。住院。

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